GOODRICH DAIRY INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GOODRICH DAIRY INC MEDICAL BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2019: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 0 |
| 2018: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 110 |
| Total of all active and inactive participants | 2018-01-01 | 110 |
| Total participants | 2018-01-01 | 110 |
| 2017: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 109 |
| Total of all active and inactive participants | 2017-07-01 | 109 |
| Total participants | 2017-07-01 | 109 |
| Number of employers contributing to the scheme | 2017-07-01 | 3 |
| 2016: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 119 |
| Total of all active and inactive participants | 2016-07-01 | 119 |
| Total participants | 2016-07-01 | 119 |
| Number of employers contributing to the scheme | 2016-07-01 | 3 |
| 2015: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 127 |
| Total of all active and inactive participants | 2015-07-01 | 127 |
| Total participants | 2015-07-01 | 127 |
| Number of employers contributing to the scheme | 2015-07-01 | 3 |
| 2014: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 121 |
| Total of all active and inactive participants | 2014-07-01 | 121 |
| Total participants | 2014-07-01 | 121 |
| Number of employers contributing to the scheme | 2014-07-01 | 3 |
| 2013: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 115 |
| Total of all active and inactive participants | 2013-07-01 | 115 |
| Total participants | 2013-07-01 | 115 |
| Number of employers contributing to the scheme | 2013-07-01 | 3 |
| 2012: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 109 |
| Total of all active and inactive participants | 2012-07-01 | 109 |
| Total participants | 2012-07-01 | 109 |
| Number of employers contributing to the scheme | 2012-07-01 | 6 |
| 2011: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 115 |
| Total of all active and inactive participants | 2011-07-01 | 115 |
| Total participants | 2011-07-01 | 115 |
| Number of employers contributing to the scheme | 2011-07-01 | 6 |
| 2010: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 115 |
| Total of all active and inactive participants | 2010-07-01 | 115 |
| Total participants | 2010-07-01 | 115 |
| Number of employers contributing to the scheme | 2010-07-01 | 6 |
| 2009: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 114 |
| Total of all active and inactive participants | 2009-07-01 | 114 |
| Total participants | 2009-07-01 | 114 |
| Measure | Date | Value |
|---|
| 2019 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $0 |
| Total plan liabilities at beginning of year | 2019-12-31 | $0 |
| Total income from all sources | 2019-12-31 | $185,145 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $185,145 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $177,896 |
| Total plan assets at end of year | 2019-12-31 | $0 |
| Total plan assets at beginning of year | 2019-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $7,249 |
| Other income received | 2019-12-31 | $22,460 |
| Net income (gross income less expenses) | 2019-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $162,685 |
| 2018 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $0 |
| Total plan liabilities at beginning of year | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $1,182,866 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,182,866 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $1,170,381 |
| Total plan assets at end of year | 2018-12-31 | $0 |
| Total plan assets at beginning of year | 2018-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $12,485 |
| Other income received | 2018-12-31 | $16,294 |
| Net income (gross income less expenses) | 2018-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $1,166,572 |
| 2017 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $0 |
| Total income from all sources | 2017-12-31 | $521,171 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $521,171 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $519,891 |
| Total plan assets at end of year | 2017-12-31 | $0 |
| Total plan assets at beginning of year | 2017-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $1,280 |
| Other income received | 2017-12-31 | $3,883 |
| 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 | $517,288 |
| Total plan liabilities at end of year | 2017-06-30 | $0 |
| Total plan liabilities at beginning of year | 2017-06-30 | $0 |
| Total income from all sources | 2017-06-30 | $1,308,283 |
| Expenses. Total of all expenses incurred | 2017-06-30 | $1,308,283 |
| Benefits paid (including direct rollovers) | 2017-06-30 | $1,304,458 |
| Total plan assets at end of year | 2017-06-30 | $0 |
| Total plan assets at beginning of year | 2017-06-30 | $0 |
| Expenses. Other expenses not covered elsewhere | 2017-06-30 | $3,825 |
| Other income received | 2017-06-30 | $3,083 |
| Net income (gross income less expenses) | 2017-06-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-06-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2017-06-30 | $1,305,200 |
| 2016 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-06-30 | $0 |
| Total plan liabilities at beginning of year | 2016-06-30 | $0 |
| Total income from all sources | 2016-06-30 | $1,275,133 |
| Expenses. Total of all expenses incurred | 2016-06-30 | $1,275,133 |
| Benefits paid (including direct rollovers) | 2016-06-30 | $1,273,083 |
| Total plan assets at end of year | 2016-06-30 | $0 |
| Total plan assets at beginning of year | 2016-06-30 | $0 |
| Expenses. Other expenses not covered elsewhere | 2016-06-30 | $2,050 |
| Other income received | 2016-06-30 | $1,133 |
| Net income (gross income less expenses) | 2016-06-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-06-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2016-06-30 | $1,274,000 |
| 2015 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-06-30 | $1,289,410 |
| Expenses. Total of all expenses incurred | 2015-06-30 | $1,289,410 |
| Benefits paid (including direct rollovers) | 2015-06-30 | $1,287,435 |
| Expenses. Other expenses not covered elsewhere | 2015-06-30 | $1,975 |
| Other income received | 2015-06-30 | $56 |
| Net income (gross income less expenses) | 2015-06-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-06-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2015-06-30 | $1,289,354 |
| 2014 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-06-30 | $1,378,228 |
| Expenses. Total of all expenses incurred | 2014-06-30 | $1,378,228 |
| Benefits paid (including direct rollovers) | 2014-06-30 | $1,375,803 |
| Expenses. Other expenses not covered elsewhere | 2014-06-30 | $2,425 |
| Other income received | 2014-06-30 | $13 |
| Net income (gross income less expenses) | 2014-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2014-06-30 | $1,378,215 |
| 2013 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-06-30 | $1,269,272 |
| Expenses. Total of all expenses incurred | 2013-06-30 | $1,269,272 |
| Benefits paid (including direct rollovers) | 2013-06-30 | $1,267,672 |
| Expenses. Other expenses not covered elsewhere | 2013-06-30 | $1,600 |
| Other income received | 2013-06-30 | $4 |
| Net income (gross income less expenses) | 2013-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2013-06-30 | $1,269,268 |
| 2012 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-06-30 | $945,789 |
| Expenses. Total of all expenses incurred | 2012-06-30 | $945,789 |
| Benefits paid (including direct rollovers) | 2012-06-30 | $944,189 |
| Expenses. Other expenses not covered elsewhere | 2012-06-30 | $1,600 |
| Other income received | 2012-06-30 | $2 |
| Net income (gross income less expenses) | 2012-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2012-06-30 | $945,787 |
| 2011 : GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-06-30 | $840,721 |
| Expenses. Total of all expenses incurred | 2011-06-30 | $840,721 |
| Benefits paid (including direct rollovers) | 2011-06-30 | $839,121 |
| Expenses. Other expenses not covered elsewhere | 2011-06-30 | $1,600 |
| Other income received | 2011-06-30 | $2 |
| Net income (gross income less expenses) | 2011-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2011-06-30 | $840,719 |
| 2019: GOODRICH DAIRY INC MEDICAL BENEFIT 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 | Yes |
| 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: GOODRICH DAIRY INC MEDICAL BENEFIT 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: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Multi-employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Multi-employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Multi-employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Multi-employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Multi-employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Multi-employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Multi-employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Multi-employer plan |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GOODRICH DAIRY INC MEDICAL BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Multi-employer plan |
| 2009-07-01 | Submission has been amended | No |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 2 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 339 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,277 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $16,415 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,458 | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GLIUME001330 |
| Policy instance | 1 |
| Insurance contract or identification number | GLIUME001330 | | Number of Individuals Covered | 110 | | 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 $181,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 2 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 379 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,709 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $17,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,742 | | Insurance broker organization code? | 3 | | Insurance broker name | FIRST INSURANCE GROUP |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI70512 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI70512 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2017-12-31 | | 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 $88,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI70512 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI70512 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $167,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 2 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 379 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,160 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $16,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $790 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT GROUP INC |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI-70512 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI-70512 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $165,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 2 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 137 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,022 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | A&D | | 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 $9,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $506 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT GROUP INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 2 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 136 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,731 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | A&D | | 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 $8,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $433 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT GROUP INC |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI-70512 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI-70512 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $154,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI-70512 |
| Policy instance | 2 |
| Insurance contract or identification number | CLI-70512 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $161,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 1 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 117 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,446 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,084 | | Insurance broker organization code? | 3 | | Insurance broker name | FIRST INS GROUP LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 1 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 115 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,072 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A&D | | Welfare Benefit Premiums Paid to Carrier | USD $4,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI-70512 |
| Policy instance | 2 |
| Insurance contract or identification number | CLI-70512 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 26581 ) |
| Policy contract number | IAIC-M-005-09 |
| Policy instance | 2 |
| Insurance contract or identification number | IAIC-M-005-09 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $153,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 870693G |
| Policy instance | 1 |
| Insurance contract or identification number | 870693G | | Number of Individuals Covered | 116 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $976 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A&D | | Welfare Benefit Premiums Paid to Carrier | USD $4,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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