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HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 401k Plan overview

Plan NameHUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN
Plan identification number 502

HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HUTCHINSON REGIONAL MEDICAL CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:HUTCHINSON REGIONAL MEDICAL CENTER, INC.
Employer identification number (EIN):480774005
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01KEVIN CHILES KEVIN CHILES2018-10-08
5022016-01-01CASSANDRA DOLEN CASSANDRA DOLEN2017-09-19
5022015-01-01CASSANDRA DOLEN CASSANDRA DOLEN2016-10-17
5022014-01-01CASSANDRA DOLEN CASSANDRA DOLEN2015-09-15
5022013-01-01KEVIN CHILES
5022012-05-01LISA SUTTON LISA SUTTON2013-10-11
5022011-05-01JULIE WARD
5022010-05-01JANET HAMOUS
5022009-05-01JANET HAMOUS

Plan Statistics for HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN

401k plan membership statisitcs for HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN

Measure Date Value
2022: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,072
Total number of active participants reported on line 7a of the Form 55002022-01-011,159
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-011,159
2021: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,108
Total number of active participants reported on line 7a of the Form 55002021-01-011,050
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-011,050
2020: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,096
Total number of active participants reported on line 7a of the Form 55002020-01-011,108
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-011,108
2019: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,104
Total number of active participants reported on line 7a of the Form 55002019-01-011,096
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,096
2018: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,098
Total number of active participants reported on line 7a of the Form 55002018-01-011,024
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,024
2017: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01958
Total number of active participants reported on line 7a of the Form 55002017-01-011,083
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-011,083
2016: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,099
Total number of active participants reported on line 7a of the Form 55002016-01-01958
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01958
2015: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,093
Total number of active participants reported on line 7a of the Form 55002015-01-011,099
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,099
2014: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,069
Total number of active participants reported on line 7a of the Form 55002014-01-011,093
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,093
2013: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01929
Total number of active participants reported on line 7a of the Form 55002013-01-011,069
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,069
2012: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-011,288
Total number of active participants reported on line 7a of the Form 55002012-05-011,225
Total of all active and inactive participants2012-05-011,225
2011: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-011,413
Total number of active participants reported on line 7a of the Form 55002011-05-011,288
Total of all active and inactive participants2011-05-011,288
Total participants2011-05-011,288
2010: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-011,479
Total number of active participants reported on line 7a of the Form 55002010-05-011,413
Total of all active and inactive participants2010-05-011,413
Total participants2010-05-011,413
2009: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-011,331
Total number of active participants reported on line 7a of the Form 55002009-05-011,479
Total of all active and inactive participants2009-05-011,479
Total participants2009-05-011,479

Form 5500 Responses for HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN

2022: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 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 planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2011 form 5500 responses
2011-05-01Type of plan entityMulti-employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2010 form 5500 responses
2010-05-01Type of plan entityMulti-employer plan
2010-05-01Submission has been amendedNo
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: HUTCHINSON REGIONAL MEDICAL CENTER AND AFFILIATES - GROUP INSURANCE PLAN 2009 form 5500 responses
2009-05-01Type of plan entityMulti-employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number837171
Policy instance 1
Insurance contract or identification number837171
Number of Individuals Covered1159
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $85,014
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $566,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,014
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number837171
Policy instance 1
Insurance contract or identification number837171
Number of Individuals Covered1055
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $50,615
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $444,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,615
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number805202G
Policy instance 3
Insurance contract or identification number805202G
Number of Individuals Covered1108
Insurance policy start date2020-04-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $38,923
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $277,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,923
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0473692-SHORT
Policy instance 2
Insurance contract or identification number0473692-SHORT
Number of Individuals Covered1084
Insurance policy start date2020-01-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $19,948
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $140,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,948
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number837176
Policy instance 1
Insurance contract or identification number837176
Number of Individuals Covered84
Insurance policy start date2020-10-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,188
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,188
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0473692
Policy instance 1
Insurance contract or identification number0473692
Number of Individuals Covered1096
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $68,921
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $550,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,921
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0473692
Policy instance 1
Insurance contract or identification number0473692
Number of Individuals Covered1091
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $46,432
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $338,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,432
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0473692
Policy instance 1
Insurance contract or identification number0473692
Number of Individuals Covered1083
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $60,777
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $444,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,777
Insurance broker organization code?3
Insurance broker nameFEE INSURANCE GROUP
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number473692
Policy instance 2
Insurance contract or identification number473692
Number of Individuals Covered1099
Insurance policy start date2015-08-01
Insurance policy end date2015-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $133,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466318
Policy instance 1
Insurance contract or identification number5466318
Number of Individuals Covered1107
Insurance policy start date2015-01-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $16,859
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $189,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,859
Insurance broker organization code?3
Insurance broker nameFEE INSURANCE GROUP INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466318
Policy instance 1
Insurance contract or identification number5466318
Number of Individuals Covered1093
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $30,160
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $340,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,010
Insurance broker organization code?3
Insurance broker nameFEE INSURANCE GROUP INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466318
Policy instance 1
Insurance contract or identification number5466318
Number of Individuals Covered1222
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $30,934
Total amount of fees paid to insurance companyUSD $17,087
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $345,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,934
Amount paid for insurance broker fees17087
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM PAYMENT AND NON MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker namePOWER GROUP COMPANY LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number502374
Policy instance 1
Insurance contract or identification number502374
Number of Individuals Covered1255
Insurance policy start date2012-05-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,901
Total amount of fees paid to insurance companyUSD $367
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $134,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,412
Insurance broker organization code?3
Amount paid for insurance broker fees367
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker namePOWER GROUP COMPANY LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number502374
Policy instance 1
Insurance contract or identification number502374
Number of Individuals Covered1288
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $6,854
Life Insurance Welfare BenefitYes
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number502374
Policy instance 1
Insurance contract or identification number502374
Number of Individuals Covered1413
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $6,711
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $6,711
Insurance broker organization code?3
Insurance broker nameBENEFIT PLUS INC

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