HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN
401k plan membership statisitcs for HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2022: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 77 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 81 |
| Total of all active and inactive participants | 2022-01-01 | 81 |
| Total participants | 2022-01-01 | 81 |
| 2021: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 77 |
| Total of all active and inactive participants | 2021-01-01 | 77 |
| Total participants | 2021-01-01 | 77 |
| 2020: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 75 |
| Total of all active and inactive participants | 2020-01-01 | 75 |
| Total participants | 2020-01-01 | 75 |
| 2019: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 75 |
| Total of all active and inactive participants | 2019-01-01 | 75 |
| Total participants | 2019-01-01 | 75 |
| 2018: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 75 |
| Total of all active and inactive participants | 2018-01-01 | 75 |
| Total participants | 2018-01-01 | 75 |
| 2017: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 71 |
| Total of all active and inactive participants | 2017-01-01 | 71 |
| Total participants | 2017-01-01 | 71 |
| 2016: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 62 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 69 |
| Total of all active and inactive participants | 2016-01-01 | 69 |
| Total participants | 2016-01-01 | 69 |
| 2015: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 60 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 62 |
| Total of all active and inactive participants | 2015-01-01 | 62 |
| Total participants | 2015-01-01 | 62 |
| 2014: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 60 |
| Total of all active and inactive participants | 2014-01-01 | 60 |
| Total participants | 2014-01-01 | 60 |
| 2013: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 52 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 55 |
| Total of all active and inactive participants | 2013-01-01 | 55 |
| Total participants | 2013-01-01 | 55 |
| 2012: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 52 |
| Total of all active and inactive participants | 2012-01-01 | 52 |
| Total participants | 2012-01-01 | 52 |
| 2011: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 60 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 55 |
| Total of all active and inactive participants | 2011-01-01 | 55 |
| Total participants | 2011-01-01 | 55 |
| Measure | Date | Value |
|---|
| 2022 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $287,384 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $287,384 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $287,384 |
| Net income (gross income less expenses) | 2022-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $287,384 |
| 2021 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $0 |
| Total plan liabilities at beginning of year | 2021-12-31 | $0 |
| Total income from all sources | 2021-12-31 | $286,606 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $286,606 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $286,606 |
| Net income (gross income less expenses) | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $286,606 |
| 2020 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $235,235 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $235,235 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $235,235 |
| Net income (gross income less expenses) | 2020-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $235,235 |
| 2019 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $205,806 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $205,806 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $205,806 |
| Net income (gross income less expenses) | 2019-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $205,806 |
| 2018 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $175,932 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $175,932 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $175,932 |
| Net income (gross income less expenses) | 2018-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $175,932 |
| 2017 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $167,679 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $167,679 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $167,679 |
| Total plan assets at end of year | 2017-12-31 | $0 |
| Total plan assets at beginning of year | 2017-12-31 | $0 |
| Net income (gross income less expenses) | 2017-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $167,679 |
| 2016 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $161,527 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $161,527 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $161,527 |
| Total plan assets at end of year | 2016-12-31 | $0 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Net income (gross income less expenses) | 2016-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $161,527 |
| 2015 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $193,237 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $193,237 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $193,237 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net income (gross income less expenses) | 2015-12-31 | $0 |
| 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 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $193,237 |
| 2014 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $153,637 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $153,637 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $153,637 |
| Total plan assets at end of year | 2014-12-31 | $0 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Net income (gross income less expenses) | 2014-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $153,637 |
| 2013 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $109,282 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $109,282 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $109,282 |
| Total plan assets at end of year | 2013-12-31 | $0 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Net income (gross income less expenses) | 2013-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $109,282 |
| 2012 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $98,484 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $98,484 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $98,484 |
| Total plan assets at end of year | 2012-12-31 | $0 |
| Total plan assets at beginning of year | 2012-12-31 | $0 |
| Net income (gross income less expenses) | 2012-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $98,484 |
| 2011 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $100,374 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $100,374 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $100,374 |
| Total plan assets at end of year | 2011-12-31 | $0 |
| Total plan assets at beginning of year | 2011-12-31 | $0 |
| Net income (gross income less expenses) | 2011-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $100,374 |
| 2010 : HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $95,636 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $95,636 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $95,636 |
| Total plan assets at end of year | 2010-12-31 | $0 |
| Total plan assets at beginning of year | 2010-12-31 | $0 |
| Net income (gross income less expenses) | 2010-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $95,636 |
| 2022: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: HORIZONTAL BORING & TUNNELING CO. HEALTH CARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | ECU-0450-GL-2 |
| Policy instance | 1 |
| Insurance contract or identification number | ECU-0450-GL-2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $25,866 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $287,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,076 | | Additional information about fees paid to insurance broker | TPA | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | ECU-0450-GL |
| Policy instance | 1 |
| Insurance contract or identification number | ECU-0450-GL | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $286,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,396 | | Additional information about fees paid to insurance broker | TPA | | Insurance broker organization code? | 3 |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US1181432 |
| Policy instance | 1 |
| Insurance contract or identification number | US1181432 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $235,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,874 | | Additional information about fees paid to insurance broker | TPA | | Insurance broker organization code? | 3 |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US1181203 |
| Policy instance | 1 |
| Insurance contract or identification number | US1181203 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $205,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,195 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US952479 |
| Policy instance | 1 |
| Insurance contract or identification number | US952479 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $175,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,581 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI71509 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI71509 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $39,816 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $167,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,709 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONAL CARE, INC |
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