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RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 401k Plan overview

Plan NameRUBY TUESDAY, INC. GROUP HEALTH CARE PLAN
Plan identification number 504

RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

RUBY TUESDAY, INC. has sponsored the creation of one or more 401k plans.

Company Name:RUBY TUESDAY, INC.
Employer identification number (EIN):630475239
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042015-01-01SUE BRILEY
5042015-01-01TOM WILLIAMS
5042014-01-01JILL GOLDER
5042013-01-01JILL GOLDER
5042012-01-01MICHAEL MOORE
5042011-01-01MICHAEL MOORE
5042010-01-01MARGIE DUFFY
5042009-01-01MARGIE DUFFY
5042009-01-01MARGIE DUFFY

Plan Statistics for RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN

401k plan membership statisitcs for RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN

Measure Date Value
2015: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013,770
Total number of active participants reported on line 7a of the Form 55002015-01-013,232
Number of retired or separated participants receiving benefits2015-01-0122
Total of all active and inactive participants2015-01-013,254
Total participants2015-01-013,254
Number of other retired or separated participants entitled to future benefits2015-01-010
2014: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-015,556
Total number of active participants reported on line 7a of the Form 55002014-01-013,725
Number of retired or separated participants receiving benefits2014-01-0145
Total of all active and inactive participants2014-01-013,770
Total participants2014-01-013,770
2013: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-016,106
Total number of active participants reported on line 7a of the Form 55002013-01-015,487
Number of retired or separated participants receiving benefits2013-01-0169
Total of all active and inactive participants2013-01-015,556
Total participants2013-01-015,556
2012: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-016,261
Total number of active participants reported on line 7a of the Form 55002012-01-016,033
Number of retired or separated participants receiving benefits2012-01-0173
Total of all active and inactive participants2012-01-016,106
Total participants2012-01-016,106
2011: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-015,980
Total number of active participants reported on line 7a of the Form 55002011-01-016,190
Number of retired or separated participants receiving benefits2011-01-0171
Total of all active and inactive participants2011-01-016,261
Total participants2011-01-016,261
2010: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-016,070
Total number of active participants reported on line 7a of the Form 55002010-01-015,912
Number of retired or separated participants receiving benefits2010-01-0168
Total of all active and inactive participants2010-01-015,980
Total participants2010-01-015,980
2009: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-016,955
Total number of active participants reported on line 7a of the Form 55002009-01-016,006
Number of retired or separated participants receiving benefits2009-01-0164
Total of all active and inactive participants2009-01-016,070
Total participants2009-01-016,070

Financial Data on RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN

Measure Date Value
2013 : RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$1,923,927
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$1,744,307
Total income from all sources (including contributions)2013-12-31$16,663,132
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$16,663,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$15,046,236
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$16,663,132
Value of total assets at end of year2013-12-31$1,923,927
Value of total assets at beginning of year2013-12-31$1,744,307
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$1,616,896
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$12,440
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$5,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$8,276,078
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$97,640
Liabilities. Value of operating payables at end of year2013-12-31$12,440
Liabilities. Value of operating payables at beginning of year2013-12-31$11,845
Total non interest bearing cash at end of year2013-12-31$0
Total non interest bearing cash at beginning of year2013-12-31$611,274
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$2,418,195
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$8,387,054
Employer contributions (assets) at end of year2013-12-31$1,923,927
Employer contributions (assets) at beginning of year2013-12-31$1,035,393
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$12,628,041
Contract administrator fees2013-12-31$1,604,456
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$1,911,487
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$1,732,462
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31CROWE HORWATH LLP
Accountancy firm EIN2013-12-31350921680
2012 : RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,744,307
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,583,977
Total income from all sources (including contributions)2012-12-31$16,067,701
Total of all expenses incurred2012-12-31$16,067,701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$14,581,958
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$16,067,701
Value of total assets at end of year2012-12-31$1,744,307
Value of total assets at beginning of year2012-12-31$1,583,977
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$1,485,743
Administrative expenses professional fees incurred2012-12-31$11,845
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$5,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31Yes
Amount of non-exempt transactions with any party-in-interest2012-12-31$15,368
Contributions received from participants2012-12-31$8,911,261
Participant contributions at end of year2012-12-31$97,640
Participant contributions at beginning of year2012-12-31$95,087
Administrative expenses (other) incurred2012-12-31$-78,169
Liabilities. Value of operating payables at end of year2012-12-31$11,845
Liabilities. Value of operating payables at beginning of year2012-12-31$11,500
Total non interest bearing cash at end of year2012-12-31$611,274
Total non interest bearing cash at beginning of year2012-12-31$221,138
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$0
Value of net assets at end of year (total assets less liabilities)2012-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$2,494,902
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$7,156,440
Employer contributions (assets) at end of year2012-12-31$1,035,393
Employer contributions (assets) at beginning of year2012-12-31$1,267,752
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$12,087,056
Contract administrator fees2012-12-31$1,552,067
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$1,732,462
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$1,572,477
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31CROWE HORWATH, LLP
Accountancy firm EIN2012-12-31350921680
2011 : RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,583,977
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,636,930
Total income from all sources (including contributions)2011-12-31$15,868,720
Total of all expenses incurred2011-12-31$15,868,720
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$14,346,820
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$15,868,720
Value of total assets at end of year2011-12-31$1,583,977
Value of total assets at beginning of year2011-12-31$1,636,930
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,521,900
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$11,735
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$5,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31Yes
Amount of non-exempt transactions with any party-in-interest2011-12-31$20,943
Contributions received from participants2011-12-31$9,334,300
Participant contributions at end of year2011-12-31$95,087
Participant contributions at beginning of year2011-12-31$105,750
Administrative expenses (other) incurred2011-12-31$6,529
Liabilities. Value of operating payables at end of year2011-12-31$11,500
Liabilities. Value of operating payables at beginning of year2011-12-31$11,500
Total non interest bearing cash at end of year2011-12-31$221,138
Total non interest bearing cash at beginning of year2011-12-31$608,617
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$0
Value of net assets at end of year (total assets less liabilities)2011-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$2,648,031
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$6,534,420
Employer contributions (assets) at end of year2011-12-31$1,267,752
Employer contributions (assets) at beginning of year2011-12-31$922,563
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$11,698,789
Contract administrator fees2011-12-31$1,503,636
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$1,572,477
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$1,625,430
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31CROWE HORWATH, LLP
Accountancy firm EIN2011-12-31350921680
2010 : RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$1,636,930
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$1,841,132
Total income from all sources (including contributions)2010-12-31$15,649,763
Total of all expenses incurred2010-12-31$15,643,114
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$14,052,321
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$15,649,763
Value of total assets at end of year2010-12-31$1,636,930
Value of total assets at beginning of year2010-12-31$1,834,483
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$1,590,793
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$11,548
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$5,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$9,318,507
Participant contributions at end of year2010-12-31$105,750
Participant contributions at beginning of year2010-12-31$123,806
Administrative expenses (other) incurred2010-12-31$27,470
Liabilities. Value of operating payables at end of year2010-12-31$11,500
Liabilities. Value of operating payables at beginning of year2010-12-31$16,928
Total non interest bearing cash at end of year2010-12-31$608,617
Total non interest bearing cash at beginning of year2010-12-31$210,725
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$6,649
Value of net assets at end of year (total assets less liabilities)2010-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$-6,649
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$2,429,372
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$6,331,256
Employer contributions (assets) at end of year2010-12-31$922,563
Employer contributions (assets) at beginning of year2010-12-31$1,499,952
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$11,622,949
Contract administrator fees2010-12-31$1,551,775
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$1,625,430
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$1,824,204
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31CROWE HORWATH LLP
Accountancy firm EIN2010-12-31350921680

Form 5500 Responses for RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN

2015: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: RUBY TUESDAY, INC. GROUP HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number000534
Policy instance 1
Insurance contract or identification number000534
Number of Individuals Covered27
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAARP MEDICARE SUPPLEMENT PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $22,948
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 number000534
Policy instance 1
Insurance contract or identification number000534
Number of Individuals Covered31
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAARP MEDICARE SUPPLEMENT PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $25,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberST-0954-3232
Policy instance 1
Insurance contract or identification numberST-0954-3232
Number of Individuals Covered1667
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $228,074
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $228,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $228,074
Additional information about fees paid to insurance brokerADMINISTRATIVE AND CLAIM PAYMENT FEES
Insurance broker nameROBYN PIPER
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 2
Insurance contract or identification number3
Number of Individuals Covered724
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,818
Total amount of fees paid to insurance companyUSD $1,785
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $122,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,909
Amount paid for insurance broker fees1785
Insurance broker nameRUSS BLAKELY & ASSOCIATES, LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number000534
Policy instance 3
Insurance contract or identification number000534
Number of Individuals Covered32
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAARP MEDICARE SUPPLEMENT PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $27,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberST-0954-3232
Policy instance 1
Insurance contract or identification numberST-0954-3232
Number of Individuals Covered1640
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $238,196
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,381,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $238,196
Additional information about fees paid to insurance brokerADMINISTRATIVE AND CLAIM PAYMENT FEES
Insurance broker nameROBYN PIPER
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number000534
Policy instance 3
Insurance contract or identification number000534
Number of Individuals Covered35
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Other welfare benefits providedAARP MEDICARE SUPPLEMENT PLAN
Welfare Benefit Premiums Paid to CarrierUSD $29,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 2
Insurance contract or identification number3
Number of Individuals Covered724
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,039
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,596
Insurance broker nameTIS INSURANCE SERVICES INC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberST-0954-3232
Policy instance 1
Insurance contract or identification numberST-0954-3232
Number of Individuals Covered1735
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $252,117
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,521,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 2
Insurance contract or identification number3
Number of Individuals Covered762
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $10,117
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $126,465
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 number000534
Policy instance 3
Insurance contract or identification number000534
Number of Individuals Covered54
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Other welfare benefits providedAARP MEDICARE SUPPLEMENT PLAN
Welfare Benefit Premiums Paid to CarrierUSD $30,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract numberST-0954-3232
Policy instance 1
Insurance contract or identification numberST-0954-3232
Number of Individuals Covered1679
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of fees paid to insurance companyUSD $215,292
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,152,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameROBYN PIPER
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 2
Insurance contract or identification number3
Number of Individuals Covered738
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $10,658
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,658
Insurance broker nameTIS INSURANCE SERVICES - 05-1257
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number000534
Policy instance 3
Insurance contract or identification number000534
Number of Individuals Covered40
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $35,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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