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UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 401k Plan overview

Plan NameUMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE
Plan identification number 522

UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CHEVRON MINING COMPANY has sponsored the creation of one or more 401k plans.

Company Name:CHEVRON MINING COMPANY
Employer identification number (EIN):440658937
NAIC Classification:212110
NAIC Description: Coal Mining

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5222022-01-01
5222021-01-01
5222020-01-01
5222019-01-01
5222018-01-01
5222018-01-01
5222017-01-01CLARK RUSHING
5222017-01-01
5222016-01-01CLARK RUSHING
5222016-01-01
5222015-01-01AUDREY LAMASTRO
5222015-01-01
5222014-01-01AUDREY LAMASTRO
5222014-01-01
5222013-01-01CLAUDIA POLIDORI
5222013-01-01
5222012-01-01CLAUDIA POLIDORI
5222012-01-01
5222011-01-01CLAUDIA POLIDORI
5222011-01-01
5222010-01-01CLAUDIA POLIDORI
5222010-01-01
5222009-04-01CLAUDIA POLIDORI
5222009-04-01
5222008-04-01
5222007-04-01
5222006-04-01
5222005-04-01
5222004-04-01
5222003-04-01
5222002-04-01
5222001-04-01

Plan Statistics for UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE

401k plan membership statisitcs for UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE

Measure Date Value
2022: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2022 401k membership
Total participants, beginning-of-year2022-01-01723
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01693
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01693
2021: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2021 401k membership
Total participants, beginning-of-year2021-01-01753
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-01722
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01722
2020: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2020 401k membership
Total participants, beginning-of-year2020-01-01837
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-01754
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01754
2019: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2019 401k membership
Total participants, beginning-of-year2019-01-01842
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01839
Number of other retired or separated participants entitled to future benefits2019-01-0121
Total of all active and inactive participants2019-01-01860
2018: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2018 401k membership
Total participants, beginning-of-year2018-01-01384
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01391
Number of other retired or separated participants entitled to future benefits2018-01-0116
Total of all active and inactive participants2018-01-01407
2017: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2017 401k membership
Total participants, beginning-of-year2017-01-01387
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-01392
Number of other retired or separated participants entitled to future benefits2017-01-0117
Total of all active and inactive participants2017-01-01409
2016: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2016 401k membership
Total participants, beginning-of-year2016-01-01373
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-01395
Number of other retired or separated participants entitled to future benefits2016-01-0118
Total of all active and inactive participants2016-01-01413
2015: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2015 401k membership
Total participants, beginning-of-year2015-01-01362
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-01379
Number of other retired or separated participants entitled to future benefits2015-01-0129
Total of all active and inactive participants2015-01-01408
2014: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2014 401k membership
Total participants, beginning-of-year2014-01-01359
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-01381
Number of other retired or separated participants entitled to future benefits2014-01-0141
Total of all active and inactive participants2014-01-01422
2013: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2013 401k membership
Total participants, beginning-of-year2013-01-01319
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-01350
Number of other retired or separated participants entitled to future benefits2013-01-0165
Total of all active and inactive participants2013-01-01415
2012: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2012 401k membership
Total participants, beginning-of-year2012-01-01340
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-01866
Number of other retired or separated participants entitled to future benefits2012-01-01115
Total of all active and inactive participants2012-01-01981
2011: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2011 401k membership
Total participants, beginning-of-year2011-01-01551
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-01210
Number of other retired or separated participants entitled to future benefits2011-01-01130
Total of all active and inactive participants2011-01-01340
2010: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2010 401k membership
Total participants, beginning-of-year2010-01-01566
Total number of active participants reported on line 7a of the Form 55002010-01-01290
Number of retired or separated participants receiving benefits2010-01-01261
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01551
2009: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2009 401k membership
Total participants, beginning-of-year2009-04-01549
Total number of active participants reported on line 7a of the Form 55002009-04-01277
Number of retired or separated participants receiving benefits2009-04-01289
Number of other retired or separated participants entitled to future benefits2009-04-010
Total of all active and inactive participants2009-04-01566
2008: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2008 401k membership
Total participants, beginning-of-year2008-04-01805
Total number of active participants reported on line 7a of the Form 55002008-04-01420
Number of retired or separated participants receiving benefits2008-04-01291
Number of other retired or separated participants entitled to future benefits2008-04-0162
Total of all active and inactive participants2008-04-01773
2007: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2007 401k membership
Total participants, beginning-of-year2007-04-01819
Total number of active participants reported on line 7a of the Form 55002007-04-01436
Number of retired or separated participants receiving benefits2007-04-01320
Number of other retired or separated participants entitled to future benefits2007-04-0149
Total of all active and inactive participants2007-04-01805
2006: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2006 401k membership
Total participants, beginning-of-year2006-04-01770
Total number of active participants reported on line 7a of the Form 55002006-04-01449
Number of retired or separated participants receiving benefits2006-04-01284
Number of other retired or separated participants entitled to future benefits2006-04-0154
Total of all active and inactive participants2006-04-01787
2005: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2005 401k membership
Total participants, beginning-of-year2005-04-01752
Total number of active participants reported on line 7a of the Form 55002005-04-01460
Number of retired or separated participants receiving benefits2005-04-01278
Number of other retired or separated participants entitled to future benefits2005-04-0132
Total of all active and inactive participants2005-04-01770
2004: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2004 401k membership
Total participants, beginning-of-year2004-04-01753
Total number of active participants reported on line 7a of the Form 55002004-04-01475
Number of retired or separated participants receiving benefits2004-04-01277
Number of other retired or separated participants entitled to future benefits2004-04-010
Total of all active and inactive participants2004-04-01752
2003: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2003 401k membership
Total participants, beginning-of-year2003-04-01806
Total number of active participants reported on line 7a of the Form 55002003-04-01472
Number of retired or separated participants receiving benefits2003-04-01280
Number of other retired or separated participants entitled to future benefits2003-04-011
Total of all active and inactive participants2003-04-01753
2002: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2002 401k membership
Total participants, beginning-of-year2002-04-011,092
Total number of active participants reported on line 7a of the Form 55002002-04-01503
Number of retired or separated participants receiving benefits2002-04-01263
Number of other retired or separated participants entitled to future benefits2002-04-0140
Total of all active and inactive participants2002-04-01806
2001: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2001 401k membership
Total participants, beginning-of-year2001-04-01965
Total number of active participants reported on line 7a of the Form 55002001-04-01883
Number of retired or separated participants receiving benefits2001-04-01180
Number of other retired or separated participants entitled to future benefits2001-04-0129
Total of all active and inactive participants2001-04-011,092

Form 5500 Responses for UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE

2022: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2009-04-01Plan is a collectively bargained planYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes
2008: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2008 form 5500 responses
2008-04-01Type of plan entitySingle employer plan
2008-04-01Submission has been amendedYes
2008-04-01This submission is the final filingNo
2008-04-01This return/report is a short plan year return/report (less than 12 months)No
2008-04-01Plan is a collectively bargained planYes
2008-04-01Plan funding arrangement – General assets of the sponsorYes
2008-04-01Plan benefit arrangement – General assets of the sponsorYes
2007: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2007 form 5500 responses
2007-04-01Type of plan entitySingle employer plan
2007-04-01Submission has been amendedYes
2007-04-01This submission is the final filingNo
2007-04-01This return/report is a short plan year return/report (less than 12 months)No
2007-04-01Plan is a collectively bargained planYes
2007-04-01Plan funding arrangement – InsuranceYes
2007-04-01Plan funding arrangement – General assets of the sponsorYes
2007-04-01Plan benefit arrangement – InsuranceYes
2007-04-01Plan benefit arrangement – General assets of the sponsorYes
2006: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2006 form 5500 responses
2006-04-01Type of plan entitySingle employer plan
2006-04-01Submission has been amendedYes
2006-04-01This submission is the final filingNo
2006-04-01This return/report is a short plan year return/report (less than 12 months)No
2006-04-01Plan is a collectively bargained planYes
2006-04-01Plan funding arrangement – InsuranceYes
2006-04-01Plan funding arrangement – General assets of the sponsorYes
2006-04-01Plan benefit arrangement – InsuranceYes
2006-04-01Plan benefit arrangement – General assets of the sponsorYes
2005: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2005 form 5500 responses
2005-04-01Type of plan entitySingle employer plan
2005-04-01Submission has been amendedYes
2005-04-01This submission is the final filingNo
2005-04-01This return/report is a short plan year return/report (less than 12 months)No
2005-04-01Plan is a collectively bargained planYes
2005-04-01Plan funding arrangement – InsuranceYes
2005-04-01Plan funding arrangement – General assets of the sponsorYes
2005-04-01Plan benefit arrangement – InsuranceYes
2005-04-01Plan benefit arrangement – General assets of the sponsorYes
2004: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2004 form 5500 responses
2004-04-01Type of plan entitySingle employer plan
2004-04-01Submission has been amendedYes
2004-04-01This submission is the final filingNo
2004-04-01This return/report is a short plan year return/report (less than 12 months)No
2004-04-01Plan is a collectively bargained planYes
2004-04-01Plan funding arrangement – InsuranceYes
2004-04-01Plan funding arrangement – General assets of the sponsorYes
2004-04-01Plan benefit arrangement – InsuranceYes
2004-04-01Plan benefit arrangement – General assets of the sponsorYes
2003: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2003 form 5500 responses
2003-04-01Type of plan entitySingle employer plan
2003-04-01Submission has been amendedYes
2003-04-01This submission is the final filingNo
2003-04-01This return/report is a short plan year return/report (less than 12 months)No
2003-04-01Plan is a collectively bargained planYes
2003-04-01Plan funding arrangement – InsuranceYes
2003-04-01Plan funding arrangement – General assets of the sponsorYes
2003-04-01Plan benefit arrangement – InsuranceYes
2003-04-01Plan benefit arrangement – General assets of the sponsorYes
2002: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2002 form 5500 responses
2002-04-01Type of plan entitySingle employer plan
2002-04-01Submission has been amendedYes
2002-04-01This submission is the final filingNo
2002-04-01This return/report is a short plan year return/report (less than 12 months)No
2002-04-01Plan is a collectively bargained planYes
2002-04-01Plan funding arrangement – InsuranceYes
2002-04-01Plan funding arrangement – General assets of the sponsorYes
2002-04-01Plan benefit arrangement – InsuranceYes
2002-04-01Plan benefit arrangement – General assets of the sponsorYes
2001: UMWA BENEFIT PLAN OF CHEVRON MINING COMPANY AT THE NORTH RIVER MINE 2001 form 5500 responses
2001-04-01Type of plan entitySingle employer plan
2001-04-01Submission has been amendedYes
2001-04-01This submission is the final filingNo
2001-04-01This return/report is a short plan year return/report (less than 12 months)No
2001-04-01Plan is a collectively bargained planYes
2001-04-01Plan funding arrangement – InsuranceYes
2001-04-01Plan funding arrangement – General assets of the sponsorYes
2001-04-01Plan benefit arrangement – InsuranceYes
2001-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered933
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered868
Insurance policy start date2006-06-01
Insurance policy end date2006-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12274566
Policy instance 2
Insurance contract or identification number12274566
Number of Individuals Covered1389
Insurance policy start date2006-01-01
Insurance policy end date2006-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered520
Insurance policy start date2005-04-01
Insurance policy end date2006-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12244106
Policy instance 2
Insurance contract or identification number12244106
Number of Individuals Covered1201
Insurance policy start date2005-01-01
Insurance policy end date2005-12-31
Total amount of commissions paid to insurance brokerUSD $765
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $765
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered521
Insurance policy start date2004-04-01
Insurance policy end date2005-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered501
Insurance policy start date2003-04-01
Insurance policy end date2004-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered477
Insurance policy start date2002-04-01
Insurance policy end date2003-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )
Policy contract number15001, 39054
Policy instance 1
Insurance contract or identification number15001, 39054
Number of Individuals Covered442
Insurance policy start date2001-04-01
Insurance policy end date2002-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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