DICKENSON-RUSSELL CONTURA, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES
401k plan membership statisitcs for DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES
| Measure | Date | Value |
|---|
| 2022: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 72 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 55 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 66 |
| 2021: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 67 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 62 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 73 |
| 2020: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 65 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 56 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 67 |
| 2019: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 54 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 65 |
| 2018: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 62 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 53 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 64 |
| 2017: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 65 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 51 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 62 |
| 2016: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-26 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-26 | 54 |
| Number of retired or separated participants receiving benefits | 2016-07-26 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2016-07-26 | 0 |
| Total of all active and inactive participants | 2016-07-26 | 65 |
| Measure | Date | Value |
|---|
| 2022 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $-148,230 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $588,440 |
| Total plan assets at beginning of year | 2022-12-31 | $736,670 |
| Value of fidelity bond covering the plan | 2022-12-31 | $5,000,000 |
| Other income received | 2022-12-31 | $-148,230 |
| Net income (gross income less expenses) | 2022-12-31 | $-148,230 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $588,440 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $736,670 |
| 2021 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $108,403 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $736,670 |
| Total plan assets at beginning of year | 2021-12-31 | $628,267 |
| Value of fidelity bond covering the plan | 2021-12-31 | $5,000,000 |
| Other income received | 2021-12-31 | $108,403 |
| Net income (gross income less expenses) | 2021-12-31 | $108,403 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $736,670 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $628,267 |
| 2020 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $109,845 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $0 |
| Total plan assets at end of year | 2020-12-31 | $628,267 |
| Total plan assets at beginning of year | 2020-12-31 | $518,422 |
| Value of fidelity bond covering the plan | 2020-12-31 | $5,000,000 |
| Other income received | 2020-12-31 | $109,845 |
| Net income (gross income less expenses) | 2020-12-31 | $109,845 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $628,267 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $518,422 |
| 2019 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $102,532 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $0 |
| Total plan assets at end of year | 2019-12-31 | $518,422 |
| Total plan assets at beginning of year | 2019-12-31 | $415,890 |
| Other income received | 2019-12-31 | $102,532 |
| Net income (gross income less expenses) | 2019-12-31 | $102,532 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $518,422 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $415,890 |
| 2018 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $-64,905 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $0 |
| Total plan assets at end of year | 2018-12-31 | $415,890 |
| Total plan assets at beginning of year | 2018-12-31 | $480,795 |
| Other income received | 2018-12-31 | $-64,905 |
| Net income (gross income less expenses) | 2018-12-31 | $-64,905 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $415,890 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $480,795 |
| Assets. Value of real-estate (other than employer real property) | 2018-12-31 | $892 |
| 2017 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $69,209 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $0 |
| Total plan assets at end of year | 2017-12-31 | $480,795 |
| Total plan assets at beginning of year | 2017-12-31 | $411,586 |
| Other income received | 2017-12-31 | $69,209 |
| Net income (gross income less expenses) | 2017-12-31 | $69,209 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $480,795 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $411,586 |
| Assets. Value of assets in partnership/joint-venture interests | 2017-12-31 | $150 |
| Assets. Value of real-estate (other than employer real property) | 2017-12-31 | $6,025 |
| 2016 : DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2016 401k financial data |
|---|
| Transfers to/from the plan | 2016-12-31 | $406,397 |
| Total income from all sources | 2016-12-31 | $5,189 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $0 |
| Total plan assets at end of year | 2016-12-31 | $411,586 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Other income received | 2016-12-31 | $5,189 |
| Net income (gross income less expenses) | 2016-12-31 | $5,189 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $411,586 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| Assets. Value of assets in partnership/joint-venture interests | 2016-12-31 | $1,000 |
| Assets. Value of real-estate (other than employer real property) | 2016-12-31 | $15,514 |
| 2022: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: DICKENSON-RUSSELL CONTURA WELFARE BENEFIT PLAN FOR UMWA REPRESENTED EMPLOYEES 2016 form 5500 responses |
|---|
| 2016-07-26 | Type of plan entity | Single employer plan |
| 2016-07-26 | First time form 5500 has been submitted | Yes |
| 2016-07-26 | Submission has been amended | No |
| 2016-07-26 | This submission is the final filing | No |
| 2016-07-26 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-07-26 | Plan is a collectively bargained plan | No |
| 2016-07-26 | Plan funding arrangement – Insurance | Yes |
| 2016-07-26 | Plan funding arrangement – Trust | Yes |
| 2016-07-26 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-07-26 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-26 | Plan benefit arrangement - Trust | Yes |
| 2016-07-26 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $19,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $270 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 261 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,809 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1793 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,300 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1293 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 52606-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 52606-1 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,554 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1550 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Insurance broker name | AXA ASSISTANCE, USA |
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