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COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 401k Plan overview

Plan NameCOIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE
Plan identification number 501

COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 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
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

COIN ACCEPTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name:COIN ACCEPTORS, INC.
Employer identification number (EIN):430743023
NAIC Classification:339900

Additional information about COIN ACCEPTORS, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 2003-09-29
Company Identification Number: 284673
Legal Registered Office Address: 505 5TH AVENUE
SUITE 729
DES MOINES
United States of America (USA)
50309

More information about COIN ACCEPTORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-10-01DANIEL J. RING2019-07-12
5012016-10-01DANIEL J. RING
5012015-10-01DANIEL J. RING
5012014-10-01DANIEL J RING
5012013-10-01
5012012-10-01DANIEL J. RING
5012011-10-01DANIEL J. RING
5012009-10-01DANIEL J. RING
5012008-10-01

Plan Statistics for COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE

401k plan membership statisitcs for COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE

Measure Date Value
2017: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-10-01225
Total number of active participants reported on line 7a of the Form 55002017-10-01207
Total of all active and inactive participants2017-10-01207
2016: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-10-01251
Total number of active participants reported on line 7a of the Form 55002016-10-01225
Number of retired or separated participants receiving benefits2016-10-014
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01229
2015: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-10-01283
Total number of active participants reported on line 7a of the Form 55002015-10-01223
Number of retired or separated participants receiving benefits2015-10-015
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01228
2014: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-10-01602
Total number of active participants reported on line 7a of the Form 55002014-10-01627
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01627
2013: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-10-01232
Total number of active participants reported on line 7a of the Form 55002013-10-01194
Number of retired or separated participants receiving benefits2013-10-012
Total of all active and inactive participants2013-10-01196
2012: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-10-01260
Total number of active participants reported on line 7a of the Form 55002012-10-01230
Number of retired or separated participants receiving benefits2012-10-012
Total of all active and inactive participants2012-10-01232
2011: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-10-01289
Total number of active participants reported on line 7a of the Form 55002011-10-01258
Number of retired or separated participants receiving benefits2011-10-012
Total of all active and inactive participants2011-10-01260
2009: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-10-01334
Total number of active participants reported on line 7a of the Form 55002009-10-01273
Number of retired or separated participants receiving benefits2009-10-0114
Total of all active and inactive participants2009-10-01287

Form 5500 Responses for COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE

2017: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
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
2009: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01This submission is the final filingNo
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: COIN ACCEPTORS, INC. & SUBSIDIARIES EMPLOYEES GROUP INSURANCE 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

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336443
Policy instance 4
Insurance contract or identification number3336443
Number of Individuals Covered171
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $107,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00481620
Policy instance 3
Insurance contract or identification number00481620
Number of Individuals Covered207
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $3,389
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD, OPT LIFE, CI
Welfare Benefit Premiums Paid to CarrierUSD $71,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 )
Policy contract number15013201
Policy instance 1
Insurance contract or identification number15013201
Number of Individuals Covered75
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number77712000
Policy instance 2
Insurance contract or identification number77712000
Number of Individuals Covered128
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $813
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number77711000
Policy instance 2
Insurance contract or identification number77711000
Number of Individuals Covered134
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $206
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $47,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees206
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00481620
Policy instance 1
Insurance contract or identification number00481620
Number of Individuals Covered223
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D AND CRITICAL ILLNESS
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 $74,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 )
Policy contract number15013201
Policy instance 3
Insurance contract or identification number15013201
Number of Individuals Covered79
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Are there contracts with allocated funds for individual policies?No
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 $6,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number481620
Policy instance 1
Insurance contract or identification number481620
Number of Individuals Covered627
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $383
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT CRITICAL ILLNESS
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 $218,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Amount paid for insurance broker fees383
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336443
Policy instance 3
Insurance contract or identification number3336443
Number of Individuals Covered346
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $132,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDTRAK SERVICES LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUH000C0I
Policy instance 2
Insurance contract or identification numberUH000C0I
Number of Individuals Covered194
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00481620
Policy instance 1
Insurance contract or identification number00481620
Number of Individuals Covered226
Insurance policy start date2014-01-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,517
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $118,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2517
Additional information about fees paid to insurance brokerFEES
Insurance broker nameHOLMES MURPHY AND ASSOC INC
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number7651-1000
Policy instance 2
Insurance contract or identification number7651-1000
Number of Individuals Covered230
Insurance policy start date2012-10-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3336443
Policy instance 5
Insurance contract or identification number3336443
Number of Individuals Covered393
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $123,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL19130
Policy instance 1
Insurance contract or identification numberHCL19130
Number of Individuals Covered268
Insurance policy start date2012-10-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $26,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00481620
Policy instance 3
Insurance contract or identification number00481620
Number of Individuals Covered288
Insurance policy start date2013-01-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDTRAK SERVICES LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUH000C0I
Policy instance 4
Insurance contract or identification numberUH000C0I
Number of Individuals Covered230
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDTRAK SERVICES LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUH000C0I
Policy instance 4
Insurance contract or identification numberUH000C0I
Number of Individuals Covered258
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677877G
Policy instance 3
Insurance contract or identification number677877G
Number of Individuals Covered258
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number7651-1000
Policy instance 2
Insurance contract or identification number7651-1000
Number of Individuals Covered258
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number710677
Policy instance 1
Insurance contract or identification number710677
Number of Individuals Covered262
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $28,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDTRAK SERVICES LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUH000C0I
Policy instance 4
Insurance contract or identification numberUH000C0I
Number of Individuals Covered287
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677877G
Policy instance 3
Insurance contract or identification number677877G
Number of Individuals Covered287
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $961
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number7651-1000
Policy instance 2
Insurance contract or identification number7651-1000
Number of Individuals Covered287
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number710677
Policy instance 1
Insurance contract or identification number710677
Number of Individuals Covered282
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $118,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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