GENERAL NOVELTY, LTD. has sponsored the creation of one or more 401k plans.
Additional information about GENERAL NOVELTY, LTD.
Submission information for form 5500 for 401k plan WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS
401k plan membership statisitcs for WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS
| Measure | Date | Value |
|---|
| 2015 : WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2015 401k financial data |
|---|
| Total transfer of assets to this plan | 2015-01-31 | $992,652 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-01-31 | $12,950 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-01-31 | $1,003,708 |
| Total income from all sources (including contributions) | 2015-01-31 | $1,349,422 |
| Total of all expenses incurred | 2015-01-31 | $1,469,475 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-01-31 | $1,468,804 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-01-31 | $1,349,405 |
| Value of total assets at end of year | 2015-01-31 | $38,540 |
| Value of total assets at beginning of year | 2015-01-31 | $156,699 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-01-31 | $671 |
| Total interest from all sources | 2015-01-31 | $17 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-01-31 | No |
| Was this plan covered by a fidelity bond | 2015-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-01-31 | No |
| Contributions received from participants | 2015-01-31 | $451,006 |
| Administrative expenses (other) incurred | 2015-01-31 | $671 |
| Liabilities. Value of operating payables at end of year | 2015-01-31 | $12,950 |
| Liabilities. Value of operating payables at beginning of year | 2015-01-31 | $1,003,708 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
| Value of net income/loss | 2015-01-31 | $-120,053 |
| Value of net assets at end of year (total assets less liabilities) | 2015-01-31 | $25,590 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-01-31 | $-847,009 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-01-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-01-31 | $38,540 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-01-31 | $156,699 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-01-31 | $156,699 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-01-31 | $17 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-01-31 | $1,468,804 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-01-31 | No |
| Contributions received in cash from employer | 2015-01-31 | $898,399 |
| Did the plan have assets held for investment | 2015-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-01-31 | Disclaimer |
| 2014 : WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-01-31 | $1,003,708 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-01-31 | $1,210,004 |
| Total income from all sources (including contributions) | 2014-01-31 | $2,015,200 |
| Total of all expenses incurred | 2014-01-31 | $1,804,468 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-01-31 | $1,785,202 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-01-31 | $2,015,004 |
| Value of total assets at end of year | 2014-01-31 | $156,699 |
| Value of total assets at beginning of year | 2014-01-31 | $152,263 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-01-31 | $19,266 |
| Total interest from all sources | 2014-01-31 | $196 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-01-31 | No |
| Administrative expenses professional fees incurred | 2014-01-31 | $19,000 |
| Was this plan covered by a fidelity bond | 2014-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-01-31 | No |
| Contributions received from participants | 2014-01-31 | $603,689 |
| Administrative expenses (other) incurred | 2014-01-31 | $266 |
| Liabilities. Value of operating payables at end of year | 2014-01-31 | $1,003,708 |
| Liabilities. Value of operating payables at beginning of year | 2014-01-31 | $1,210,004 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
| Value of net income/loss | 2014-01-31 | $210,732 |
| Value of net assets at end of year (total assets less liabilities) | 2014-01-31 | $-847,009 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-01-31 | $-1,057,741 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-01-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-01-31 | $156,699 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-01-31 | $152,263 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-01-31 | $152,263 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-01-31 | $196 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-01-31 | $1,785,202 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-01-31 | No |
| Contributions received in cash from employer | 2014-01-31 | $1,411,315 |
| Did the plan have assets held for investment | 2014-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-01-31 | No |
| 2013 : WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-01-31 | $1,210,004 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-01-31 | $1,465,109 |
| Total income from all sources (including contributions) | 2013-01-31 | $2,026,221 |
| Total of all expenses incurred | 2013-01-31 | $1,780,868 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-01-31 | $1,761,868 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-01-31 | $2,026,145 |
| Value of total assets at end of year | 2013-01-31 | $152,263 |
| Value of total assets at beginning of year | 2013-01-31 | $162,015 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-01-31 | $19,000 |
| Total interest from all sources | 2013-01-31 | $76 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-01-31 | No |
| Administrative expenses professional fees incurred | 2013-01-31 | $19,000 |
| Was this plan covered by a fidelity bond | 2013-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-01-31 | No |
| Contributions received from participants | 2013-01-31 | $514,343 |
| Liabilities. Value of operating payables at end of year | 2013-01-31 | $1,210,004 |
| Liabilities. Value of operating payables at beginning of year | 2013-01-31 | $1,465,109 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-01-31 | No |
| Value of net income/loss | 2013-01-31 | $245,353 |
| Value of net assets at end of year (total assets less liabilities) | 2013-01-31 | $-1,057,741 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-01-31 | $-1,303,094 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-01-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-01-31 | $152,263 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-01-31 | $162,015 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-01-31 | $162,015 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-01-31 | $76 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-01-31 | $1,761,868 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-01-31 | No |
| Contributions received in cash from employer | 2013-01-31 | $1,511,802 |
| Did the plan have assets held for investment | 2013-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-01-31 | No |
| 2012 : WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-01-31 | $1,465,109 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-01-31 | $1,557,021 |
| Total income from all sources (including contributions) | 2012-01-31 | $1,983,666 |
| Total of all expenses incurred | 2012-01-31 | $1,902,281 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-01-31 | $1,883,241 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-01-31 | $1,983,587 |
| Value of total assets at end of year | 2012-01-31 | $162,015 |
| Value of total assets at beginning of year | 2012-01-31 | $172,542 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-01-31 | $19,040 |
| Total interest from all sources | 2012-01-31 | $79 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-01-31 | No |
| Was this plan covered by a fidelity bond | 2012-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-01-31 | No |
| Contributions received from participants | 2012-01-31 | $576,986 |
| Administrative expenses (other) incurred | 2012-01-31 | $19,040 |
| Liabilities. Value of operating payables at end of year | 2012-01-31 | $1,465,109 |
| Liabilities. Value of operating payables at beginning of year | 2012-01-31 | $1,557,021 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-01-31 | No |
| Value of net income/loss | 2012-01-31 | $81,385 |
| Value of net assets at end of year (total assets less liabilities) | 2012-01-31 | $-1,303,094 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-01-31 | $-1,384,479 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-01-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-01-31 | $162,015 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-01-31 | $172,542 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-01-31 | $172,542 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-01-31 | $79 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-01-31 | $1,883,241 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-01-31 | No |
| Contributions received in cash from employer | 2012-01-31 | $1,406,601 |
| Did the plan have assets held for investment | 2012-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-01-31 | No |
| 2011 : WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-01-31 | $1,557,021 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-01-31 | $1,773,610 |
| Total income from all sources (including contributions) | 2011-01-31 | $2,246,373 |
| Total of all expenses incurred | 2011-01-31 | $2,093,406 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-01-31 | $2,083,385 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-01-31 | $2,244,780 |
| Value of total assets at end of year | 2011-01-31 | $172,542 |
| Value of total assets at beginning of year | 2011-01-31 | $236,164 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-01-31 | $10,021 |
| Total interest from all sources | 2011-01-31 | $1,593 |
| Was this plan covered by a fidelity bond | 2011-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-01-31 | No |
| Contributions received from participants | 2011-01-31 | $604,869 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-01-31 | $301,339 |
| Administrative expenses (other) incurred | 2011-01-31 | $10,021 |
| Liabilities. Value of operating payables at end of year | 2011-01-31 | $1,557,021 |
| Liabilities. Value of operating payables at beginning of year | 2011-01-31 | $1,773,610 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-01-31 | No |
| Value of net income/loss | 2011-01-31 | $152,967 |
| Value of net assets at end of year (total assets less liabilities) | 2011-01-31 | $-1,384,479 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-01-31 | $-1,537,446 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-01-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-01-31 | $172,542 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-01-31 | $236,164 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-01-31 | $236,164 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-01-31 | $1,593 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-01-31 | $84,341 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-01-31 | No |
| Contributions received in cash from employer | 2011-01-31 | $1,639,911 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-01-31 | $1,697,705 |
| Did the plan have assets held for investment | 2011-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-01-31 | No |
| 2017: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | Yes |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | DFE (Diect Filing Entity) |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement - Trust | Yes |
| 2013: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | DFE (Diect Filing Entity) |
| 2013-02-01 | Submission has been amended | Yes |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement - Trust | Yes |
| 2012: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | DFE (Diect Filing Entity) |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement - Trust | Yes |
| 2011: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | DFE (Diect Filing Entity) |
| 2011-02-01 | Submission has been amended | Yes |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement - Trust | Yes |
| 2009: WALKER COMPONENT GROUP, INC. HEALTH AND WELFARE BENEFITS 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | DFE (Diect Filing Entity) |
| 2009-02-01 | Submission has been amended | Yes |
| 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) | No |
| 2009-02-01 | Plan is a collectively bargained plan | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement - Trust | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SOK605143 |
| Policy instance | 5 |
| Insurance contract or identification number | SOK605143 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $318 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $2,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $318 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM607164 |
| Policy instance | 4 |
| Insurance contract or identification number | SGM607164 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,634 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | 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 $24,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,634 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGD607483 |
| Policy instance | 3 |
| Insurance contract or identification number | SGD607483 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,337 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | 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 $13,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,337 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGD607482 |
| Policy instance | 2 |
| Insurance contract or identification number | SGD607482 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,091 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | 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 $10,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,091 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00615002 |
| Policy instance | 1 |
| Insurance contract or identification number | 00615002 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,791 | | Total amount of fees paid to insurance company | USD $59,762 | | 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 | Yes | | Vision Insurance Welfare Benefit | Yes | | 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 $1,289,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,791 | | Amount paid for insurance broker fees | 59762 | | Additional information about fees paid to insurance broker | BENEFIT ADVISOR FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 485086 |
| Policy instance | 4 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $27,186 | | 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 | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | 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 $741,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,186 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 485086 |
| Policy instance | 3 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $41,562 | | 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 | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | 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 $1,410,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,152 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING INC-DENVER CO |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,227 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,227 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 1 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $5,736 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,736 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 4 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $940 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $940 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 3 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 124 | | Total amount of commissions paid to insurance broker | USD $2,046 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,046 | | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 98 | | Total amount of commissions paid to insurance broker | USD $2,750 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $2,750 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 485086 |
| Policy instance | 1 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $41,562 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,410,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,410 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 3 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,824 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,824 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | AON CONSULTING,INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 485086 |
| Policy instance | 1 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $53,937 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,731,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,937 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker name | AON CONSULTING,INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,314 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,314 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | AON CONSULTING,INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Total amount of commissions paid to insurance broker | USD $2,873 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,873 | | Insurance broker name | AON CONSULTING,INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 3 |
| Insurance contract or identification number | 140293 | | Total amount of commissions paid to insurance broker | USD $2,748 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,748 | | Insurance broker name | AON CONSULTING,INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 485086 |
| Policy instance | 1 |
| Insurance contract or identification number | 485086 | | Total amount of commissions paid to insurance broker | USD $53,502 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,714,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,502 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker name | AON CONSULTING,INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,227 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 3 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,322 | | Life Insurance Welfare Benefit | Yes | | 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 | 485086 |
| Policy instance | 1 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $57,766 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,785,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 3 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $3,260 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 140293 |
| Policy instance | 2 |
| Insurance contract or identification number | 140293 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $2,985 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | 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 | 485086 |
| Policy instance | 1 |
| Insurance contract or identification number | 485086 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $67,213 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
