TR-STATE TRUCK CENTER, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2016 : TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN 2016 401k financial data |
|---|
| Value of total assets at end of year | 2016-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-04-30 | No |
| Was this plan covered by a fidelity bond | 2016-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2016-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-04-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2016-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-04-30 | No |
| Did the plan have assets held for investment | 2016-04-30 | 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 | 2016-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-04-30 | No |
| 2015 : TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN 2015 401k financial data |
|---|
| Value of total assets at end of year | 2015-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-04-30 | No |
| Was this plan covered by a fidelity bond | 2015-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2015-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-04-30 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2015-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-04-30 | No |
| Did the plan have assets held for investment | 2015-04-30 | 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 | 2015-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-04-30 | No |
| 2014 : TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN 2014 401k financial data |
|---|
| Value of total assets at end of year | 2014-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-07-31 | No |
| Was this plan covered by a fidelity bond | 2014-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2014-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-07-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-07-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-07-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-07-31 | No |
| Did the plan have assets held for investment | 2014-07-31 | 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 | 2014-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-07-31 | No |
| 2012 : TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN 2012 401k financial data |
|---|
| Value of total assets at end of year | 2012-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2012-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Did the plan have assets held for investment | 2012-12-31 | 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 | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Total unrealized appreciation/depreciation of assets | 2012-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-07-31 | $0 |
| Total income from all sources (including contributions) | 2012-07-31 | $0 |
| Total loss/gain on sale of assets | 2012-07-31 | $0 |
| Total of all expenses incurred | 2012-07-31 | $0 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-07-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-07-31 | $0 |
| Value of total assets at end of year | 2012-07-31 | $0 |
| Value of total assets at beginning of year | 2012-07-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-07-31 | $0 |
| Total interest from all sources | 2012-07-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-07-31 | $0 |
| Was this plan covered by a fidelity bond | 2012-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-07-31 | No |
| Value of net income/loss | 2012-07-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2012-07-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-07-31 | No |
| Did the plan have assets held for investment | 2012-07-31 | 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 | 2012-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-07-31 | No |
| 2010 : TRI-STATE TRUCK CENTER, INC. HEALTH & WELFARE BENEFITS PLAN 2010 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2010-07-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-07-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-07-31 | $0 |
| Total income from all sources (including contributions) | 2010-07-31 | $0 |
| Total loss/gain on sale of assets | 2010-07-31 | $0 |
| Total of all expenses incurred | 2010-07-31 | $0 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-07-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-07-31 | $0 |
| Value of total assets at end of year | 2010-07-31 | $0 |
| Value of total assets at beginning of year | 2010-07-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-07-31 | $0 |
| Total interest from all sources | 2010-07-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-07-31 | $0 |
| Was this plan covered by a fidelity bond | 2010-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-07-31 | No |
| Value of net income/loss | 2010-07-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2010-07-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-07-31 | No |
| Did the plan have assets held for investment | 2010-07-31 | 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 | 2010-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-07-31 | No |
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 05471 |
| Policy instance | 4 |
| Insurance contract or identification number | 05471 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Health Insurance Welfare Benefit | Yes | | 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 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417002411815 |
| Policy instance | 3 |
| Insurance contract or identification number | 417002411815 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-08-01 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2TSTC413 |
| Policy instance | 2 |
| Insurance contract or identification number | 2TSTC413 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | 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 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-04-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417002411815 |
| Policy instance | 3 |
| Insurance contract or identification number | 417002411815 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-04-30 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2TSTC413 |
| Policy instance | 2 |
| Insurance contract or identification number | 2TSTC413 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | 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 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-04-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 2TSTC413 |
| Policy instance | 3 |
| Insurance contract or identification number | 2TSTC413 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | 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 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0742722 |
| Policy instance | 1 |
| Insurance contract or identification number | 0742722 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-04-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $139,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-04-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 124805 |
| Policy instance | 3 |
| Insurance contract or identification number | 124805 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | 11470-11477-D |
| Policy instance | 4 |
| Insurance contract or identification number | 11470-11477-D | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | 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 | 0742722 |
| Policy instance | 5 |
| Insurance contract or identification number | 0742722 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,144,305 | | 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 | 0742722 |
| Policy instance | 1 |
| Insurance contract or identification number | 0742722 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,089,929 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 2 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-04-01 | | 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 | | 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 $111,961 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 00466451 |
| Policy instance | 3 |
| Insurance contract or identification number | 00466451 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | 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 | 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 $102,401 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AFW9 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AFW9 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-04-01 | | 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 | | 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 $110,934 |
|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 124805 |
| Policy instance | 2 |
| Insurance contract or identification number | 124805 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,892 |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | 1147011477D |
| Policy instance | 1 |
| Insurance contract or identification number | 1147011477D | | Number of Individuals Covered | 250132 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | 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 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010041866 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010041866 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2009-03-01 | | Insurance policy end date | 2010-02-28 | | Total amount of commissions paid to insurance broker | USD $15,215 | | 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
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| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | 1147011477D |
| Policy instance | 3 |
| Insurance contract or identification number | 1147011477D | | Number of Individuals Covered | 129 | | Insurance policy start date | 2009-04-01 | | Insurance policy end date | 2010-03-31 | | 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 |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0717308 |
| Policy instance | 2 |
| Insurance contract or identification number | 0717308 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
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