ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND
401k plan membership statisitcs for ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND
| Measure | Date | Value |
|---|
| 2015: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 0 |
| Total of all active and inactive participants | 2015-05-01 | 0 |
| Number of employers contributing to the scheme | 2015-05-01 | 1 |
| 2014: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 0 |
| Total of all active and inactive participants | 2014-05-01 | 0 |
| Number of employers contributing to the scheme | 2014-05-01 | 0 |
| 2013: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 69 |
| Total of all active and inactive participants | 2013-05-01 | 69 |
| Number of employers contributing to the scheme | 2013-05-01 | 2 |
| 2012: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 66 |
| Total of all active and inactive participants | 2012-05-01 | 66 |
| Number of employers contributing to the scheme | 2012-05-01 | 2 |
| 2011: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 74 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 73 |
| Total of all active and inactive participants | 2011-05-01 | 73 |
| Number of employers contributing to the scheme | 2011-05-01 | 2 |
| 2010: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-05-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 75 |
| Total of all active and inactive participants | 2010-05-01 | 75 |
| Number of employers contributing to the scheme | 2010-05-01 | 3 |
| 2009: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 88 |
| Total of all active and inactive participants | 2009-05-01 | 88 |
| Number of employers contributing to the scheme | 2009-05-01 | 3 |
| Measure | Date | Value |
|---|
| 2015 : ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $0 |
| Total plan liabilities at beginning of year | 2015-12-31 | $547 |
| Total income from all sources | 2015-12-31 | $3,971 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $75,847 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $39,857 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $72,423 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Other income received | 2015-12-31 | $85 |
| Net income (gross income less expenses) | 2015-12-31 | $-71,876 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $71,876 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $3,886 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $35,990 |
| Total plan liabilities at end of year | 2015-04-30 | $547 |
| Total plan liabilities at beginning of year | 2015-04-30 | $2,812 |
| Total income from all sources | 2015-04-30 | $386,423 |
| Expenses. Total of all expenses incurred | 2015-04-30 | $586,294 |
| Benefits paid (including direct rollovers) | 2015-04-30 | $530,029 |
| Total plan assets at end of year | 2015-04-30 | $72,423 |
| Total plan assets at beginning of year | 2015-04-30 | $274,559 |
| Value of fidelity bond covering the plan | 2015-04-30 | $500,000 |
| Total contributions received or receivable from participants | 2015-04-30 | $4,104 |
| Expenses. Other expenses not covered elsewhere | 2015-04-30 | $5,195 |
| Other income received | 2015-04-30 | $413 |
| Net income (gross income less expenses) | 2015-04-30 | $-199,871 |
| Net plan assets at end of year (total assets less liabilities) | 2015-04-30 | $71,876 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-04-30 | $271,747 |
| Total contributions received or receivable from employer(s) | 2015-04-30 | $381,906 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-04-30 | $51,070 |
| 2014 : ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-04-30 | $117,442 |
| Total plan liabilities at beginning of year | 2014-04-30 | $113,899 |
| Total income from all sources | 2014-04-30 | $750,596 |
| Expenses. Total of all expenses incurred | 2014-04-30 | $735,173 |
| Benefits paid (including direct rollovers) | 2014-04-30 | $673,816 |
| Total plan assets at end of year | 2014-04-30 | $274,559 |
| Total plan assets at beginning of year | 2014-04-30 | $255,593 |
| Value of fidelity bond covering the plan | 2014-04-30 | $500,000 |
| Total contributions received or receivable from participants | 2014-04-30 | $3,954 |
| Expenses. Other expenses not covered elsewhere | 2014-04-30 | $5,808 |
| Other income received | 2014-04-30 | $340 |
| Net income (gross income less expenses) | 2014-04-30 | $15,423 |
| Net plan assets at end of year (total assets less liabilities) | 2014-04-30 | $157,117 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-04-30 | $141,694 |
| Total contributions received or receivable from employer(s) | 2014-04-30 | $746,302 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-04-30 | $55,549 |
| 2013 : ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-04-30 | $113,899 |
| Total plan liabilities at beginning of year | 2013-04-30 | $110,224 |
| Total income from all sources | 2013-04-30 | $722,915 |
| Expenses. Total of all expenses incurred | 2013-04-30 | $755,699 |
| Benefits paid (including direct rollovers) | 2013-04-30 | $687,718 |
| Total plan assets at end of year | 2013-04-30 | $255,593 |
| Total plan assets at beginning of year | 2013-04-30 | $284,702 |
| Value of fidelity bond covering the plan | 2013-04-30 | $500,000 |
| Total contributions received or receivable from participants | 2013-04-30 | $11,683 |
| Expenses. Other expenses not covered elsewhere | 2013-04-30 | $8,619 |
| Other income received | 2013-04-30 | $471 |
| Net income (gross income less expenses) | 2013-04-30 | $-32,784 |
| Net plan assets at end of year (total assets less liabilities) | 2013-04-30 | $141,694 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-04-30 | $174,478 |
| Total contributions received or receivable from employer(s) | 2013-04-30 | $710,761 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-04-30 | $59,362 |
| 2012 : ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-04-30 | $110,224 |
| Total plan liabilities at beginning of year | 2012-04-30 | $116,763 |
| Total income from all sources | 2012-04-30 | $719,796 |
| Expenses. Total of all expenses incurred | 2012-04-30 | $800,977 |
| Benefits paid (including direct rollovers) | 2012-04-30 | $741,941 |
| Total plan assets at end of year | 2012-04-30 | $284,702 |
| Total plan assets at beginning of year | 2012-04-30 | $372,422 |
| Value of fidelity bond covering the plan | 2012-04-30 | $500,000 |
| Total contributions received or receivable from participants | 2012-04-30 | $7,223 |
| Other income received | 2012-04-30 | $733 |
| Net income (gross income less expenses) | 2012-04-30 | $-81,181 |
| Net plan assets at end of year (total assets less liabilities) | 2012-04-30 | $174,478 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-04-30 | $255,659 |
| Total contributions received or receivable from employer(s) | 2012-04-30 | $711,840 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-04-30 | $59,036 |
| 2011 : ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-04-30 | $116,763 |
| Total plan liabilities at beginning of year | 2011-04-30 | $129,069 |
| Total income from all sources | 2011-04-30 | $777,431 |
| Expenses. Total of all expenses incurred | 2011-04-30 | $883,820 |
| Benefits paid (including direct rollovers) | 2011-04-30 | $818,782 |
| Total plan assets at end of year | 2011-04-30 | $372,422 |
| Total plan assets at beginning of year | 2011-04-30 | $491,117 |
| Value of fidelity bond covering the plan | 2011-04-30 | $500,000 |
| Total contributions received or receivable from participants | 2011-04-30 | $1 |
| Other income received | 2011-04-30 | $1,417 |
| Net income (gross income less expenses) | 2011-04-30 | $-106,389 |
| Net plan assets at end of year (total assets less liabilities) | 2011-04-30 | $255,659 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-04-30 | $362,048 |
| Total contributions received or receivable from employer(s) | 2011-04-30 | $776,013 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-04-30 | $65,038 |
| 2015: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Multi-employer plan |
| 2015-05-01 | This submission is the final filing | Yes |
| 2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-05-01 | Plan is a collectively bargained plan | Yes |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – Trust | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement - Trust | Yes |
| 2014: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Multi-employer plan |
| 2014-05-01 | Plan is a collectively bargained plan | Yes |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – Trust | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement - Trust | Yes |
| 2013: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Multi-employer plan |
| 2013-05-01 | Plan is a collectively bargained plan | Yes |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan funding arrangement – Trust | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement - Trust | Yes |
| 2012: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Multi-employer plan |
| 2012-05-01 | Plan is a collectively bargained plan | Yes |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan funding arrangement – Trust | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement - Trust | Yes |
| 2011: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Multi-employer plan |
| 2011-05-01 | Plan is a collectively bargained plan | Yes |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – Trust | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement - Trust | Yes |
| 2010: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2010 form 5500 responses |
|---|
| 2010-05-01 | Type of plan entity | Multi-employer plan |
| 2010-05-01 | Plan is a collectively bargained plan | Yes |
| 2010-05-01 | Plan funding arrangement – Insurance | Yes |
| 2010-05-01 | Plan funding arrangement – Trust | Yes |
| 2010-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-05-01 | Plan benefit arrangement - Trust | Yes |
| 2009: ST LOUIS BAKERS UNION LOCAL 4 HEALTH AND WELFARE FUND 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Multi-employer plan |
| 2009-05-01 | Submission has been amended | Yes |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | Plan is a collectively bargained plan | Yes |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan funding arrangement – Trust | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement - Trust | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D026497 |
| Policy instance | 2 |
| Insurance contract or identification number | 00001D026497 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $178 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,848 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $178 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010176963 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010176963 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $22 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,890 | | 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 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010176963 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010176963 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $46 | | Total amount of fees paid to insurance company | USD $129 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $4,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46 | | Amount paid for insurance broker fees | 129 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 6205300000 |
| Policy instance | 1 |
| Insurance contract or identification number | 6205300000 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $9,075 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $453,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,075 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INSURANCE AGENCY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D026497 |
| Policy instance | 3 |
| Insurance contract or identification number | 00001D026497 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $336 | | Total amount of fees paid to insurance company | USD $239 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $336 | | Amount paid for insurance broker fees | 239 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F017418 |
| Policy instance | 2 |
| Insurance contract or identification number | F017418 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $57 | | 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 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $57 | | Insurance broker organization code? | 3 | | Insurance broker name | HOLMES MURPHY AND ASSOCIATES, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D026497 |
| Policy instance | 4 |
| Insurance contract or identification number | 00001D026497 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $83 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $83 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KMO5727384 |
| Policy instance | 5 |
| Insurance contract or identification number | KMO5727384 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $645 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $645 | | Additional information about fees paid to insurance broker | BASE COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 6205300000 |
| Policy instance | 1 |
| Insurance contract or identification number | 6205300000 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $11,805 | | Total amount of fees paid to insurance company | USD $2,725 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,076 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,805 | | Amount paid for insurance broker fees | 2725 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INSURANCE AGENCY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010176963 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010176963 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $11 | | 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 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $4,313 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INS AGENCY INC |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 6205300000 |
| Policy instance | 1 |
| Insurance contract or identification number | 6205300000 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $16,096 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $606,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,096 | | Insurance broker organization code? | 3 | | Insurance broker name | DEWITT INSURANCE AGENCY INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F017418 |
| Policy instance | 3 |
| Insurance contract or identification number | F017418 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $694 | | 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 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $694 | | Insurance broker organization code? | 3 | | Insurance broker name | HOLMES MURPHY AND ASSOCIATES, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05727384 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05727384 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $2,055 | | Total amount of fees paid to insurance company | USD $12 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,055 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 12 | | Insurance broker name | HOLMES MURPHY & ASSOCIATES, INC. |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 6205300000 |
| Policy instance | 1 |
| Insurance contract or identification number | 6205300000 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $17,108 | | Total amount of fees paid to insurance company | USD $1,090 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $691,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05727384 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05727384 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $1,864 | | Total amount of fees paid to insurance company | USD $514 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,064 | | 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 | F017418 |
| Policy instance | 3 |
| Insurance contract or identification number | F017418 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $723 | | 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 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 6205300000 |
| Policy instance | 1 |
| Insurance contract or identification number | 6205300000 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $19,114 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $637,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,114 | | Insurance broker organization code? | 3 | | Insurance broker name | HOLMES MURPHY & ASSOCIATES, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05727384 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05727384 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $2,075 | | Total amount of fees paid to insurance company | USD $693 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,075 | | Amount paid for insurance broker fees | 693 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HOLMES MURPHY AND ASSOCIATES, INC. |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F017418 |
| Policy instance | 3 |
| Insurance contract or identification number | F017418 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $822 | | 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 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $822 | | Insurance broker organization code? | 3 | | Insurance broker name | HOLMES MURPHY & ASSOCIATES, INC. |
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