MONTE VISTA COOPERATIVE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN
401k plan membership statisitcs for MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 0 |
| 2021: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 64 |
| Total of all active and inactive participants | 2021-02-01 | 64 |
| 2020: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 52 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 59 |
| Number of retired or separated participants receiving benefits | 2020-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 59 |
| 2019: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 52 |
| Total of all active and inactive participants | 2019-02-01 | 52 |
| 2018: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 52 |
| Total of all active and inactive participants | 2018-02-01 | 52 |
| 2017: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 59 |
| Total of all active and inactive participants | 2017-02-01 | 59 |
| 2016: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 45 |
| Number of retired or separated participants receiving benefits | 2016-02-01 | 50 |
| Total of all active and inactive participants | 2016-02-01 | 50 |
| 2015: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 43 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 45 |
| Total of all active and inactive participants | 2015-02-01 | 45 |
| 2014: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 43 |
| Total of all active and inactive participants | 2014-02-01 | 43 |
| 2013: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 42 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 41 |
| Total of all active and inactive participants | 2013-02-01 | 41 |
| 2012: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 42 |
| Total of all active and inactive participants | 2012-02-01 | 42 |
| 2011: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 45 |
| Total of all active and inactive participants | 2011-02-01 | 45 |
| 2010: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 49 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 46 |
| Total of all active and inactive participants | 2010-02-01 | 46 |
| 2009: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 49 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 49 |
| Total of all active and inactive participants | 2009-02-01 | 49 |
| Measure | Date | Value |
|---|
| 2023 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2023 401k financial data |
|---|
| Transfers to/from the plan | 2023-01-31 | $-90,065 |
| Total plan assets at end of year | 2023-01-31 | $0 |
| Total plan assets at beginning of year | 2023-01-31 | $90,065 |
| Net plan assets at end of year (total assets less liabilities) | 2023-01-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-01-31 | $90,065 |
| 2022 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-01-31 | $706,236 |
| Expenses. Total of all expenses incurred | 2022-01-31 | $669,995 |
| Benefits paid (including direct rollovers) | 2022-01-31 | $669,995 |
| Total plan assets at end of year | 2022-01-31 | $90,065 |
| Total plan assets at beginning of year | 2022-01-31 | $53,824 |
| Total contributions received or receivable from participants | 2022-01-31 | $286,430 |
| Net income (gross income less expenses) | 2022-01-31 | $36,241 |
| Net plan assets at end of year (total assets less liabilities) | 2022-01-31 | $90,065 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-01-31 | $53,824 |
| Total contributions received or receivable from employer(s) | 2022-01-31 | $419,806 |
| 2021 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-01-31 | $475,899 |
| Expenses. Total of all expenses incurred | 2021-01-31 | $465,616 |
| Benefits paid (including direct rollovers) | 2021-01-31 | $427,561 |
| Total plan assets at end of year | 2021-01-31 | $53,824 |
| Total plan assets at beginning of year | 2021-01-31 | $43,541 |
| Total contributions received or receivable from participants | 2021-01-31 | $238,725 |
| Net income (gross income less expenses) | 2021-01-31 | $10,283 |
| Net plan assets at end of year (total assets less liabilities) | 2021-01-31 | $53,824 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-01-31 | $43,541 |
| Total contributions received or receivable from employer(s) | 2021-01-31 | $237,174 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-01-31 | $38,055 |
| 2020 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-01-31 | $363,324 |
| Expenses. Total of all expenses incurred | 2020-01-31 | $473,478 |
| Benefits paid (including direct rollovers) | 2020-01-31 | $431,716 |
| Total plan assets at end of year | 2020-01-31 | $43,541 |
| Total plan assets at beginning of year | 2020-01-31 | $153,695 |
| Total contributions received or receivable from participants | 2020-01-31 | $231,256 |
| Net income (gross income less expenses) | 2020-01-31 | $-110,154 |
| Net plan assets at end of year (total assets less liabilities) | 2020-01-31 | $43,541 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-01-31 | $153,695 |
| Total contributions received or receivable from employer(s) | 2020-01-31 | $132,068 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-01-31 | $41,762 |
| 2019 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2019 401k financial data |
|---|
| Transfers to/from the plan | 2019-01-31 | $73,054 |
| Total income from all sources | 2019-01-31 | $706,559 |
| Expenses. Total of all expenses incurred | 2019-01-31 | $706,559 |
| Benefits paid (including direct rollovers) | 2019-01-31 | $628,023 |
| Total plan assets at end of year | 2019-01-31 | $153,695 |
| Total plan assets at beginning of year | 2019-01-31 | $80,641 |
| Total contributions received or receivable from participants | 2019-01-31 | $259,155 |
| Net income (gross income less expenses) | 2019-01-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-01-31 | $153,695 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-01-31 | $80,641 |
| Total contributions received or receivable from employer(s) | 2019-01-31 | $447,404 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-01-31 | $78,536 |
| 2018 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2018 401k financial data |
|---|
| Transfers to/from the plan | 2018-02-01 | $80,641 |
| Total income from all sources | 2018-02-01 | $595,460 |
| Expenses. Total of all expenses incurred | 2018-02-01 | $595,460 |
| Benefits paid (including direct rollovers) | 2018-02-01 | $535,541 |
| Total plan assets at end of year | 2018-02-01 | $80,641 |
| Total contributions received or receivable from participants | 2018-02-01 | $235,772 |
| Net income (gross income less expenses) | 2018-02-01 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-02-01 | $80,641 |
| Total contributions received or receivable from employer(s) | 2018-02-01 | $359,688 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-02-01 | $59,919 |
| 2017 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-01-31 | $506,627 |
| Expenses. Total of all expenses incurred | 2017-01-31 | $506,627 |
| Benefits paid (including direct rollovers) | 2017-01-31 | $482,285 |
| Total contributions received or receivable from participants | 2017-01-31 | $196,559 |
| Net income (gross income less expenses) | 2017-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2017-01-31 | $310,068 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-01-31 | $24,342 |
| 2016 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-01-31 | $492,049 |
| Expenses. Total of all expenses incurred | 2016-01-31 | $492,049 |
| Benefits paid (including direct rollovers) | 2016-01-31 | $468,648 |
| Total contributions received or receivable from participants | 2016-01-31 | $181,784 |
| Net income (gross income less expenses) | 2016-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2016-01-31 | $310,265 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-01-31 | $23,401 |
| 2015 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-01-31 | $437,755 |
| Expenses. Total of all expenses incurred | 2015-01-31 | $437,755 |
| Benefits paid (including direct rollovers) | 2015-01-31 | $414,510 |
| Total contributions received or receivable from participants | 2015-01-31 | $198,300 |
| Net income (gross income less expenses) | 2015-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-01-31 | $239,455 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-01-31 | $23,245 |
| 2014 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-01-31 | $490,130 |
| Expenses. Total of all expenses incurred | 2014-01-31 | $490,130 |
| Benefits paid (including direct rollovers) | 2014-01-31 | $474,340 |
| Total contributions received or receivable from participants | 2014-01-31 | $215,421 |
| Net income (gross income less expenses) | 2014-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-01-31 | $274,709 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-01-31 | $15,790 |
| 2013 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-01-31 | $548,931 |
| Expenses. Total of all expenses incurred | 2013-01-31 | $548,931 |
| Benefits paid (including direct rollovers) | 2013-01-31 | $532,824 |
| Total contributions received or receivable from participants | 2013-01-31 | $215,455 |
| Net income (gross income less expenses) | 2013-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-01-31 | $333,476 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-01-31 | $16,107 |
| 2012 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-01-31 | $695,310 |
| Expenses. Total of all expenses incurred | 2012-01-31 | $695,310 |
| Benefits paid (including direct rollovers) | 2012-01-31 | $676,751 |
| Total contributions received or receivable from participants | 2012-01-31 | $196,722 |
| Net income (gross income less expenses) | 2012-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2012-01-31 | $498,588 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-01-31 | $18,559 |
| 2011 : MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-01-31 | $408,050 |
| Expenses. Total of all expenses incurred | 2011-01-31 | $408,050 |
| Benefits paid (including direct rollovers) | 2011-01-31 | $389,758 |
| Value of fidelity bond covering the plan | 2011-01-31 | $85,000 |
| Total contributions received or receivable from participants | 2011-01-31 | $204,025 |
| Net income (gross income less expenses) | 2011-01-31 | $0 |
| Total contributions received or receivable from employer(s) | 2011-01-31 | $204,025 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-01-31 | $18,292 |
| 2022: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | This submission is the final filing | Yes |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MONTE VISTA COOPERATIVE EMPLOYEE MEDICAL AND DENTAL BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625396 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625396 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625396 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625396 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $22,707 | | Total amount of fees paid to insurance company | USD $16,737 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,707 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16737 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625396 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625396 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $20,580 | | Total amount of fees paid to insurance company | USD $17,440 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,101 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 17440 | | Additional information about fees paid to insurance broker | ADMINISTRATION |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00625396 |
| Policy instance | 1 |
| Insurance contract or identification number | 00625396 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-02-01 | | Total amount of commissions paid to insurance broker | USD $20,750 | | Total amount of fees paid to insurance company | USD $18,307 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $191,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 18307 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $15,760 |
|
| UNITED MEDICAL RESOURCES INC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 417003412859 |
| Policy instance | 1 |
| Insurance contract or identification number | 417003412859 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $23,363 | | Total amount of fees paid to insurance company | USD $36,556 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $202,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,363 | | Amount paid for insurance broker fees | 36556 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTURY ADMIN SERVICES |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI110115 |
| Policy instance | 1 |
| Insurance contract or identification number | CLI110115 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $20,140 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,140 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTURY ADMIN SERVICES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL12672 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL12672 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $18,577 | | Total amount of fees paid to insurance company | USD $105,256 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,577 | | Amount paid for insurance broker fees | 105256 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTURY FINANCIAL GROUP |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL12672 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL12672 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $19,359 | | Total amount of fees paid to insurance company | USD $128,981 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,359 | | Amount paid for insurance broker fees | 128981 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTURY FINANCIAL GROUP |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL12672 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL12672 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $21,975 | | Total amount of fees paid to insurance company | USD $156,969 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,975 | | Amount paid for insurance broker fees | 156969 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTURY FINANCIAL GROUP |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL12672 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL12672 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $21,719 | | Total amount of fees paid to insurance company | USD $144,783 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL12672 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL12672 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $20,207 | | Total amount of fees paid to insurance company | USD $134,715 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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