DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN
401k plan membership statisitcs for DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2021: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 241 |
| Total of all active and inactive participants | 2021-09-01 | 241 |
| 2020: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 250 |
| Total of all active and inactive participants | 2020-09-01 | 250 |
| 2019: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 261 |
| Total of all active and inactive participants | 2019-09-01 | 261 |
| 2018: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 259 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 253 |
| Total of all active and inactive participants | 2018-09-01 | 253 |
| 2017: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 241 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 259 |
| Total of all active and inactive participants | 2017-09-01 | 259 |
| 2016: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 234 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 241 |
| Total of all active and inactive participants | 2016-09-01 | 241 |
| 2015: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 234 |
| Total of all active and inactive participants | 2015-09-01 | 234 |
| Total participants | 2015-09-01 | 234 |
| 2014: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 207 |
| Total of all active and inactive participants | 2014-09-01 | 207 |
| Total participants | 2014-09-01 | 207 |
| 2013: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 211 |
| Total of all active and inactive participants | 2013-09-01 | 211 |
| 2012: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 217 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 206 |
| Total of all active and inactive participants | 2012-09-01 | 206 |
| 2011: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 217 |
| Total of all active and inactive participants | 2011-09-01 | 217 |
| 2009: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 183 |
| Total of all active and inactive participants | 2009-09-01 | 183 |
| 2021: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: DEERFIELD EPISCOPAL RETIREMENT COMMUNITY, INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | OCPA1 |
| Policy instance | 4 |
| Insurance contract or identification number | OCPA1 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $10,648 | | Total amount of fees paid to insurance company | USD $388 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $69,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,692 | | Amount paid for insurance broker fees | 198 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900777 |
| Policy instance | 3 |
| Insurance contract or identification number | 900777 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $3,781 | | Total amount of fees paid to insurance company | USD $1,744 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,781 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1744 | | Additional information about fees paid to insurance broker | BONUSES AND ADDITIONAL PAYMENTS PAID |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0754001 |
| Policy instance | 2 |
| Insurance contract or identification number | 0754001 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,245 | | Total amount of fees paid to insurance company | USD $700 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,245 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 700 | | Additional information about fees paid to insurance broker | BONUS AMOUNT |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885853G |
| Policy instance | 1 |
| Insurance contract or identification number | 885853G | | Number of Individuals Covered | 241 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $5,755 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,755 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885853G |
| Policy instance | 1 |
| Insurance contract or identification number | 885853G | | Number of Individuals Covered | 250 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $6,278 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,278 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0754001 |
| Policy instance | 2 |
| Insurance contract or identification number | 0754001 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $2,430 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,118 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,799 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BONUS |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900777 |
| Policy instance | 3 |
| Insurance contract or identification number | 900777 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $3,068 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $34,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,068 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | OCPA1 |
| Policy instance | 4 |
| Insurance contract or identification number | OCPA1 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,438 | | Total amount of fees paid to insurance company | USD $193 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $55,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,394 | | Amount paid for insurance broker fees | 134 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | OCPA1 |
| Policy instance | 4 |
| Insurance contract or identification number | OCPA1 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,324 | | Total amount of fees paid to insurance company | USD $613 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $83,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,928 | | Amount paid for insurance broker fees | 398 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900777 |
| Policy instance | 3 |
| Insurance contract or identification number | 900777 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,911 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $36,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,911 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0754001 |
| Policy instance | 2 |
| Insurance contract or identification number | 0754001 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,228 | | Total amount of fees paid to insurance company | USD $703 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,193 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,525 | | Amount paid for insurance broker fees | 703 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885853G |
| Policy instance | 1 |
| Insurance contract or identification number | 885853G | | Number of Individuals Covered | 261 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $6,278 | | Total amount of fees paid to insurance company | USD $261 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,232 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 192 | | Additional information about fees paid to insurance broker | BONUS |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 885853G |
| Policy instance | 1 |
| Insurance contract or identification number | 885853G | | Number of Individuals Covered | 253 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $6,265 | | Total amount of fees paid to insurance company | USD $2,243 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,265 | | Amount paid for insurance broker fees | 2243 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0754001 |
| Policy instance | 2 |
| Insurance contract or identification number | 0754001 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,218 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,218 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900777 |
| Policy instance | 3 |
| Insurance contract or identification number | 900777 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $2,930 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,548 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,930 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | OCPA1 |
| Policy instance | 4 |
| Insurance contract or identification number | OCPA1 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $13,660 | | Total amount of fees paid to insurance company | USD $612 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $72,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,629 | | Amount paid for insurance broker fees | 316 | | Additional information about fees paid to insurance broker | ADDITIONAL FEES | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | OCPA1 |
| Policy instance | 4 |
| Insurance contract or identification number | OCPA1 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $8,974 | | Total amount of fees paid to insurance company | USD $499 | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $52,760 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900777 |
| Policy instance | 3 |
| Insurance contract or identification number | 900777 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $2,832 | | Total amount of fees paid to insurance company | USD $1,166 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0754001 |
| Policy instance | 2 |
| Insurance contract or identification number | 0754001 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $2,505 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 960501 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 960501 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $7,096 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
