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CROWNQUEST OPERATING HEALTH BENEFIT PLAN 401k Plan overview

Plan NameCROWNQUEST OPERATING HEALTH BENEFIT PLAN
Plan identification number 501

CROWNQUEST OPERATING HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

CROWNQUEST OPERATING LLC has sponsored the creation of one or more 401k plans.

Company Name:CROWNQUEST OPERATING LLC
Employer identification number (EIN):752837284
NAIC Classification:211120
NAIC Description:Crude Petroleum Extraction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROWNQUEST OPERATING HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01
5012020-12-01
5012019-12-01
5012018-12-01
5012016-12-01
5012015-12-01W MICHAEL SCOTT
5012015-12-01
5012014-12-01W MICHAEL SCOTT
5012013-12-01W. MICHAEL SCOTT

Plan Statistics for CROWNQUEST OPERATING HEALTH BENEFIT PLAN

401k plan membership statisitcs for CROWNQUEST OPERATING HEALTH BENEFIT PLAN

Measure Date Value
2021: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01262
Total number of active participants reported on line 7a of the Form 55002021-12-01272
Total of all active and inactive participants2021-12-01272
2020: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01252
Total number of active participants reported on line 7a of the Form 55002020-12-01263
Total of all active and inactive participants2020-12-01263
2019: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01239
Total number of active participants reported on line 7a of the Form 55002019-12-01255
Total of all active and inactive participants2019-12-01255
2018: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01218
Total number of active participants reported on line 7a of the Form 55002018-12-01239
Total of all active and inactive participants2018-12-01239
2016: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01164
Total number of active participants reported on line 7a of the Form 55002016-12-01188
Total of all active and inactive participants2016-12-01188
Total participants2016-12-01188
2015: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01159
Total number of active participants reported on line 7a of the Form 55002015-12-01164
Total of all active and inactive participants2015-12-01164
Total participants2015-12-01164
2014: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01140
Total number of active participants reported on line 7a of the Form 55002014-12-01157
Total of all active and inactive participants2014-12-01157
Total participants2014-12-01157
2013: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01104
Total number of active participants reported on line 7a of the Form 55002013-12-01135
Total of all active and inactive participants2013-12-01135
Total participants2013-12-01135

Financial Data on CROWNQUEST OPERATING HEALTH BENEFIT PLAN

Measure Date Value
2022 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-11-30$3,686,642
Total of all expenses incurred2022-11-30$3,686,642
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-11-30$3,379,208
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-11-30$3,686,642
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-11-30$307,434
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-11-30No
Was this plan covered by a fidelity bond2022-11-30No
Were there any nonexempt tranactions with any party-in-interest2022-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2022-11-30$161,028
Administrative expenses (other) incurred2022-11-30$183,906
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Value of net income/loss2022-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-11-30No
Were any leases to which the plan was party in default or uncollectible2022-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2022-11-30$728,823
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-11-30No
Was there a failure to transmit to the plan any participant contributions2022-11-30No
Has the plan failed to provide any benefit when due under the plan2022-11-30No
Contributions received in cash from employer2022-11-30$3,525,614
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-11-30$2,650,385
Contract administrator fees2022-11-30$123,528
Did the plan have assets held for investment2022-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-11-30Yes
2021 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-11-30$4,671,912
Total of all expenses incurred2021-11-30$4,671,912
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-11-30$4,375,001
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-11-30$4,671,912
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-11-30$296,911
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-11-30No
Was this plan covered by a fidelity bond2021-11-30Yes
Value of fidelity bond cover2021-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2021-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2021-11-30$1,173,486
Administrative expenses (other) incurred2021-11-30$177,024
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Value of net income/loss2021-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-11-30No
Were any leases to which the plan was party in default or uncollectible2021-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2021-11-30$730,505
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-11-30No
Was there a failure to transmit to the plan any participant contributions2021-11-30No
Has the plan failed to provide any benefit when due under the plan2021-11-30No
Contributions received in cash from employer2021-11-30$3,498,426
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-11-30$3,644,496
Contract administrator fees2021-11-30$119,887
Did the plan have assets held for investment2021-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-11-30Yes
2020 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2020 401k financial data
Total income from all sources (including contributions)2020-11-30$3,008,169
Total of all expenses incurred2020-11-30$3,008,169
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-11-30$2,780,103
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-11-30$3,008,169
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-11-30$228,066
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-11-30No
Was this plan covered by a fidelity bond2020-11-30Yes
Value of fidelity bond cover2020-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2020-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2020-11-30$60,958
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-11-30$47,945
Administrative expenses (other) incurred2020-11-30$114,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Value of net income/loss2020-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-11-30No
Were any leases to which the plan was party in default or uncollectible2020-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-11-30$645,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-11-30No
Was there a failure to transmit to the plan any participant contributions2020-11-30No
Has the plan failed to provide any benefit when due under the plan2020-11-30No
Contributions received in cash from employer2020-11-30$2,947,211
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-11-30$2,086,719
Contract administrator fees2020-11-30$113,445
Did the plan have assets held for investment2020-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-11-30Yes
2019 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2019 401k financial data
Total income from all sources (including contributions)2019-11-30$3,340,083
Total of all expenses incurred2019-11-30$3,340,083
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-11-30$3,069,323
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-11-30$3,340,083
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-11-30$270,760
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-11-30No
Was this plan covered by a fidelity bond2019-11-30Yes
Value of fidelity bond cover2019-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2019-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2019-11-30$189,062
Administrative expenses (other) incurred2019-11-30$165,241
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Value of net income/loss2019-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-11-30No
Were any leases to which the plan was party in default or uncollectible2019-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-11-30$651,798
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-11-30No
Was there a failure to transmit to the plan any participant contributions2019-11-30No
Has the plan failed to provide any benefit when due under the plan2019-11-30No
Contributions received in cash from employer2019-11-30$3,151,021
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-11-30$2,417,525
Contract administrator fees2019-11-30$105,519
Did the plan have assets held for investment2019-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-11-30Yes
2017 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-11-30$3,175,152
Total of all expenses incurred2017-11-30$3,175,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$2,987,255
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$3,175,152
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$187,897
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2017-11-30$834,511
Administrative expenses (other) incurred2017-11-30$101,837
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-11-30$572,897
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30No
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$2,340,641
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$2,414,358
Contract administrator fees2017-11-30$86,060
Did the plan have assets held for investment2017-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30Yes
2016 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-11-30$2,815,086
Total of all expenses incurred2016-11-30$2,815,086
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$2,645,969
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$2,815,086
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$169,117
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2016-11-30$689,166
Administrative expenses (other) incurred2016-11-30$91,854
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-11-30$580,311
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30No
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$2,125,920
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$2,065,658
Contract administrator fees2016-11-30$77,263
Did the plan have assets held for investment2016-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30Yes
2015 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2015 401k financial data
Total income from all sources (including contributions)2015-11-30$1,961,409
Total of all expenses incurred2015-11-30$1,961,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$1,832,041
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$1,961,409
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$129,368
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-11-30No
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Income. Received or receivable in cash from other sources (including rollovers)2015-11-30$168,924
Administrative expenses (other) incurred2015-11-30$58,754
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-11-30$638,429
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30No
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$1,792,485
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$1,193,612
Contract administrator fees2015-11-30$70,614
Did the plan have assets held for investment2015-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30Yes
2014 : CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-11-30$2,021,108
Total of all expenses incurred2014-11-30$2,021,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$1,895,868
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$2,021,108
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$125,240
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-11-30No
Was this plan covered by a fidelity bond2014-11-30No
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$0
Administrative expenses (other) incurred2014-11-30$67,569
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-11-30$389,956
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30No
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$2,021,108
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$1,505,912
Contract administrator fees2014-11-30$57,671
Did the plan have assets held for investment2014-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30Yes

Form 5500 Responses for CROWNQUEST OPERATING HEALTH BENEFIT PLAN

2021: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – General assets of the sponsorYes
2015: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedYes
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – General assets of the sponsorYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – General assets of the sponsorYes
2014: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – General assets of the sponsorYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – General assets of the sponsorYes
2013: CROWNQUEST OPERATING HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01First time form 5500 has been submittedYes
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – General assets of the sponsorYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS503507
Policy instance 2
Insurance contract or identification numberS503507
Number of Individuals Covered272
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $3,512
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $35,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,512
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberS503507
Policy instance 1
Insurance contract or identification numberS503507
Number of Individuals Covered272
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of fees paid to insurance companyUSD $124,765
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $693,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees101696
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number164422
Policy instance 3
Insurance contract or identification number164422
Number of Individuals Covered261
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $15,515
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,515
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS503507
Policy instance 2
Insurance contract or identification numberS503507
Number of Individuals Covered263
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $3,351
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $33,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,351
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberS503507
Policy instance 1
Insurance contract or identification numberS503507
Number of Individuals Covered263
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of fees paid to insurance companyUSD $121,094
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $681,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees98762
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number164422
Policy instance 3
Insurance contract or identification number164422
Number of Individuals Covered261
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $15,515
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,515
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS503507
Policy instance 2
Insurance contract or identification numberS503507
Number of Individuals Covered255
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $2,989
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $29,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,989
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberS503507
Policy instance 1
Insurance contract or identification numberS503507
Number of Individuals Covered255
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of fees paid to insurance companyUSD $113,968
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $615,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees93454
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number164422
Policy instance 3
Insurance contract or identification number164422
Number of Individuals Covered246
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $15,366
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,366
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberS503507
Policy instance 1
Insurance contract or identification numberS503507
Number of Individuals Covered239
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of fees paid to insurance companyUSD $105,887
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $543,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees19060
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberS503507
Policy instance 2
Insurance contract or identification numberS503507
Number of Individuals Covered239
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $2,796
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $27,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,796
Insurance broker organization code?5

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