PREMIER FARNELL CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES
401k plan membership statisitcs for PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES
| Measure | Date | Value |
|---|
| 2017: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 85 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 85 |
| 2016: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 94 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 94 |
| 2015: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 106 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 106 |
| 2014: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 105 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 105 |
| 2013: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 107 |
| 2012: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 109 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 109 |
| 2011: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 79 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 79 |
| 2010: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 95 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 71 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 71 |
| 2009: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 95 |
| Number of retired or separated participants receiving benefits | 2009-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-02-01 | 0 |
| Total of all active and inactive participants | 2009-02-01 | 95 |
| Measure | Date | Value |
|---|
| 2016 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $605,008 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,261,455 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $1,261,455 |
| Total plan assets at end of year | 2016-12-31 | $0 |
| Total plan assets at beginning of year | 2016-12-31 | $656,447 |
| Value of fidelity bond covering the plan | 2016-12-31 | $1,000,000 |
| Other income received | 2016-12-31 | $8 |
| Net income (gross income less expenses) | 2016-12-31 | $-656,447 |
| 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 | $656,447 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $605,000 |
| 2015 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $1,684,138 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,539,000 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,539,000 |
| Total plan assets at end of year | 2015-12-31 | $656,447 |
| Total plan assets at beginning of year | 2015-12-31 | $511,309 |
| Value of fidelity bond covering the plan | 2015-12-31 | $1,000,000 |
| Other income received | 2015-12-31 | $138 |
| Net income (gross income less expenses) | 2015-12-31 | $145,138 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $656,447 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $511,309 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $1,684,000 |
| 2014 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $1,700,127 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,292,000 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,292,000 |
| Total plan assets at end of year | 2014-12-31 | $511,309 |
| Total plan assets at beginning of year | 2014-12-31 | $103,182 |
| Value of fidelity bond covering the plan | 2014-12-31 | $1,000,000 |
| Other income received | 2014-12-31 | $127 |
| Net income (gross income less expenses) | 2014-12-31 | $408,127 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $511,309 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $103,182 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,700,000 |
| 2013 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $1,250,069 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $1,267,000 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $1,267,000 |
| Total plan assets at end of year | 2013-12-31 | $103,182 |
| Total plan assets at beginning of year | 2013-12-31 | $120,113 |
| Value of fidelity bond covering the plan | 2013-12-31 | $1,000,000 |
| Other income received | 2013-12-31 | $69 |
| Net income (gross income less expenses) | 2013-12-31 | $-16,931 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $103,182 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $120,113 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $1,250,000 |
| 2012 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $1,000,053 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $1,090,000 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $1,090,000 |
| Total plan assets at end of year | 2012-12-31 | $120,113 |
| Total plan assets at beginning of year | 2012-12-31 | $210,060 |
| Value of fidelity bond covering the plan | 2012-12-31 | $1,000,000 |
| Other income received | 2012-12-31 | $53 |
| Net income (gross income less expenses) | 2012-12-31 | $-89,947 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $120,113 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $210,060 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $1,000,000 |
| 2011 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $1,000,062 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $1,021,984 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $1,021,984 |
| Total plan assets at end of year | 2011-12-31 | $210,060 |
| Total plan assets at beginning of year | 2011-12-31 | $231,982 |
| Value of fidelity bond covering the plan | 2011-12-31 | $1,000,000 |
| Other income received | 2011-12-31 | $62 |
| Net income (gross income less expenses) | 2011-12-31 | $-21,922 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $210,060 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $231,982 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $1,000,000 |
| 2010 : PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $1,001,869 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $1,130,000 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $1,130,000 |
| Total plan assets at end of year | 2010-12-31 | $231,982 |
| Total plan assets at beginning of year | 2010-12-31 | $360,113 |
| Value of fidelity bond covering the plan | 2010-12-31 | $1,000,000 |
| Other income received | 2010-12-31 | $1,869 |
| Net income (gross income less expenses) | 2010-12-31 | $-128,131 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $231,982 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $360,113 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $1,000,000 |
| 2017: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 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 funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: PREMIER FARNELL CORP. HEALTH & WELFARE BENEFITS PLAN FOR AKRON BRASS RETIREES 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Submission has been amended | No |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-02-01 | Plan is a collectively bargained plan | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – Trust | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement - Trust | Yes |
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2017-01-01 | | 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 | No | | 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 $3,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003320029 |
| Policy instance | 2 |
| Insurance contract or identification number | 003320029 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2017-01-01 | | 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 | No | | 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 $33,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | 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 $8,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003320029 |
| Policy instance | 2 |
| Insurance contract or identification number | 003320029 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | 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 $68,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,133 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $32,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,133 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,163 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $28,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,163 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
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| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,146 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $13,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,146 | | Insurance broker organization code? | 3 | | Insurance broker name | MCGOHAN BRABENDER AGENCY INC |
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| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,864 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $13,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 003329750 |
| Policy instance | 1 |
| Insurance contract or identification number | 003329750 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,264 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $12,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,264 | | Insurance broker organization code? | 3 | | Insurance broker name | MCGOHAN BRABENDER AGENCY INC |
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