COYOTE CABLING LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COYOTE CABLING LLC INSURANCE PROGRAM
| Measure | Date | Value |
|---|
| 2020: COYOTE CABLING LLC INSURANCE PROGRAM 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 5 |
| Total of all active and inactive participants | 2020-01-01 | 5 |
| 2019: COYOTE CABLING LLC INSURANCE PROGRAM 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 6 |
| Total of all active and inactive participants | 2019-01-01 | 6 |
| 2018: COYOTE CABLING LLC INSURANCE PROGRAM 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 11 |
| Total of all active and inactive participants | 2018-01-01 | 11 |
| 2017: COYOTE CABLING LLC INSURANCE PROGRAM 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 9 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| 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 | 9 |
| 2016: COYOTE CABLING LLC INSURANCE PROGRAM 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 6 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 6 |
| 2015: COYOTE CABLING LLC INSURANCE PROGRAM 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 7 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 7 |
| 2014: COYOTE CABLING LLC INSURANCE PROGRAM 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 7 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 7 |
| 2013: COYOTE CABLING LLC INSURANCE PROGRAM 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 9 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 9 |
| 2012: COYOTE CABLING LLC INSURANCE PROGRAM 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 10 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 10 |
| 2011: COYOTE CABLING LLC INSURANCE PROGRAM 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 15 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
| Total of all active and inactive participants | 2011-05-01 | 15 |
| Measure | Date | Value |
|---|
| 2020 : COYOTE CABLING LLC INSURANCE PROGRAM 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $22,459 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $22,460 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $22,459 |
| Total plan assets at end of year | 2020-12-31 | $0 |
| Total plan assets at beginning of year | 2020-12-31 | $1 |
| Net income (gross income less expenses) | 2020-12-31 | $-1 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $1 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $22,459 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $1 |
| 2019 : COYOTE CABLING LLC INSURANCE PROGRAM 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $65,370 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $67,274 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $65,904 |
| Total plan assets at end of year | 2019-12-31 | $1 |
| Total plan assets at beginning of year | 2019-12-31 | $1,905 |
| Net income (gross income less expenses) | 2019-12-31 | $-1,904 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $1 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,905 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $65,370 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $1,370 |
| 2018 : COYOTE CABLING LLC INSURANCE PROGRAM 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $52,673 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $58,199 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $56,688 |
| Total plan assets at end of year | 2018-12-31 | $1,905 |
| Total plan assets at beginning of year | 2018-12-31 | $7,431 |
| Net income (gross income less expenses) | 2018-12-31 | $-5,526 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $1,905 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $7,431 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $52,673 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $1,511 |
| 2017 : COYOTE CABLING LLC INSURANCE PROGRAM 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $43,112 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $37,259 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $37,259 |
| Total plan assets at end of year | 2017-12-31 | $7,431 |
| Total plan assets at beginning of year | 2017-12-31 | $1,578 |
| Net income (gross income less expenses) | 2017-12-31 | $5,853 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $7,431 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $1,578 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $43,112 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $0 |
| 2016 : COYOTE CABLING LLC INSURANCE PROGRAM 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $43,083 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $41,505 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $41,296 |
| Total plan assets at end of year | 2016-12-31 | $1,578 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Net income (gross income less expenses) | 2016-12-31 | $1,578 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $1,578 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $43,083 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $209 |
| 2015 : COYOTE CABLING LLC INSURANCE PROGRAM 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $33,208 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $33,208 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $31,677 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net income (gross income less expenses) | 2015-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $33,208 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $1,531 |
| 2014 : COYOTE CABLING LLC INSURANCE PROGRAM 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $30,713 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $32,622 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $27,033 |
| Total plan assets at end of year | 2014-12-31 | $0 |
| Total plan assets at beginning of year | 2014-12-31 | $1,909 |
| Value of fidelity bond covering the plan | 2014-12-31 | $50,000 |
| Net income (gross income less expenses) | 2014-12-31 | $-1,909 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $1,909 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $30,713 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $5,589 |
| 2013 : COYOTE CABLING LLC INSURANCE PROGRAM 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $38,366 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $40,819 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $40,043 |
| Total plan assets at end of year | 2013-12-31 | $1,909 |
| Total plan assets at beginning of year | 2013-12-31 | $4,362 |
| Net income (gross income less expenses) | 2013-12-31 | $-2,453 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $1,909 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $4,362 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $38,366 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $776 |
| 2012 : COYOTE CABLING LLC INSURANCE PROGRAM 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $49,821 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $54,870 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $52,429 |
| Total plan assets at end of year | 2012-12-31 | $4,362 |
| Total plan assets at beginning of year | 2012-12-31 | $9,411 |
| Net income (gross income less expenses) | 2012-12-31 | $-5,049 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $4,362 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $9,411 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $49,821 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $2,441 |
| 2011 : COYOTE CABLING LLC INSURANCE PROGRAM 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $31,808 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $22,397 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $22,305 |
| Total plan assets at end of year | 2011-12-31 | $9,411 |
| Total plan assets at beginning of year | 2011-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $92 |
| Net income (gross income less expenses) | 2011-12-31 | $9,411 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $9,411 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $31,808 |
| 2020: COYOTE CABLING LLC INSURANCE PROGRAM 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 | Yes |
| 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 benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: COYOTE CABLING LLC INSURANCE PROGRAM 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 benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: COYOTE CABLING LLC INSURANCE PROGRAM 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 benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: COYOTE CABLING LLC INSURANCE PROGRAM 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 benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: COYOTE CABLING LLC INSURANCE PROGRAM 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: COYOTE CABLING LLC INSURANCE PROGRAM 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: COYOTE CABLING LLC INSURANCE PROGRAM 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: COYOTE CABLING LLC INSURANCE PROGRAM 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: COYOTE CABLING LLC INSURANCE PROGRAM 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: COYOTE CABLING LLC INSURANCE PROGRAM 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | First time form 5500 has been submitted | Yes |
| 2011-05-01 | Submission has been amended | No |
| 2011-05-01 | This submission is the final filing | No |
| 2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-05-01 | Plan is a collectively bargained plan | No |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – Trust | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement - Trust | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 664415 |
| Policy instance | 1 |
| Insurance contract or identification number | 664415 | | Number of Individuals Covered | 5 | | 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 $0 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 664415 |
| Policy instance | 1 |
| Insurance contract or identification number | 664415 | | Number of Individuals Covered | 6 | | 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 $0 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $65,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 664415 |
| Policy instance | 1 |
| Insurance contract or identification number | 664415 | | Number of Individuals Covered | 9 | | 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 $0 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $37,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 664415 |
| Policy instance | 1 |
| Insurance contract or identification number | 664415 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $31,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 664415 |
| Policy instance | 4 |
| Insurance contract or identification number | 664415 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | N11286 |
| Policy instance | 3 |
| Insurance contract or identification number | N11286 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-08-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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| DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 ) |
| Policy contract number | 0010103 |
| Policy instance | 2 |
| Insurance contract or identification number | 0010103 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-08-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,548 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
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| LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 ) |
| Policy contract number | 20455200 |
| Policy instance | 1 |
| Insurance contract or identification number | 20455200 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-05-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
|
| DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 ) |
| Policy contract number | 0010103 |
| Policy instance | 2 |
| Insurance contract or identification number | 0010103 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
|
| LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 ) |
| Policy contract number | 20455200 |
| Policy instance | 1 |
| Insurance contract or identification number | 20455200 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $35,550 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | WESTERN INSURANCE CONSULTANTS |
|
| DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 ) |
| Policy contract number | 0010103 |
| Policy instance | 2 |
| Insurance contract or identification number | 0010103 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | BENECO |
|
| LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 ) |
| Policy contract number | 20455200 |
| Policy instance | 1 |
| Insurance contract or identification number | 20455200 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $40,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 | | Insurance broker name | BENECO |
|
| LOVELACE INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 12265 ) |
| Policy contract number | 20455200 |
| Policy instance | 1 |
| Insurance contract or identification number | 20455200 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $19,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 ) |
| Policy contract number | 0010103 |
| Policy instance | 2 |
| Insurance contract or identification number | 0010103 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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