DEY DISTRIBUTING, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN
Measure | Date | Value |
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2021: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-12-01 | 162 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 144 |
Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
Total of all active and inactive participants | 2021-12-01 | 144 |
2020: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-12-01 | 143 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 143 |
Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
Total of all active and inactive participants | 2020-12-01 | 143 |
2019: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-12-01 | 143 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 143 |
Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
Total of all active and inactive participants | 2019-12-01 | 143 |
2018: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-12-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 116 |
Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
Total of all active and inactive participants | 2018-12-01 | 116 |
2016: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-12-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 119 |
Number of retired or separated participants receiving benefits | 2016-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 2 |
Total of all active and inactive participants | 2016-12-01 | 121 |
2015: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-12-01 | 115 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 96 |
Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
Total of all active and inactive participants | 2015-12-01 | 96 |
2014: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-12-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 97 |
Number of retired or separated participants receiving benefits | 2014-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
Total of all active and inactive participants | 2014-12-01 | 97 |
2013: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-12-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 114 |
Number of retired or separated participants receiving benefits | 2013-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
Total of all active and inactive participants | 2013-12-01 | 114 |
2012: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-12-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 119 |
Number of retired or separated participants receiving benefits | 2012-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-12-01 | 0 |
Total of all active and inactive participants | 2012-12-01 | 119 |
2011: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-12-01 | 120 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 119 |
Number of retired or separated participants receiving benefits | 2011-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-12-01 | 0 |
Total of all active and inactive participants | 2011-12-01 | 119 |
2010: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-12-01 | 117 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 120 |
Number of retired or separated participants receiving benefits | 2010-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-12-01 | 0 |
Total of all active and inactive participants | 2010-12-01 | 120 |
2009: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-12-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 117 |
Number of retired or separated participants receiving benefits | 2009-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-12-01 | 0 |
Total of all active and inactive participants | 2009-12-01 | 117 |
2008: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-12-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-12-01 | 113 |
Number of retired or separated participants receiving benefits | 2008-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2008-12-01 | 0 |
Total of all active and inactive participants | 2008-12-01 | 113 |
2007: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2007 401k membership |
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Total participants, beginning-of-year | 2007-12-01 | 124 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-12-01 | 116 |
Number of retired or separated participants receiving benefits | 2007-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2007-12-01 | 0 |
Total of all active and inactive participants | 2007-12-01 | 116 |
2021: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2021 form 5500 responses |
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2021-12-01 | Type of plan entity | Single employer plan |
2021-12-01 | Submission has been amended | No |
2021-12-01 | This submission is the final filing | No |
2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-12-01 | Plan is a collectively bargained plan | No |
2021-12-01 | Plan funding arrangement – Insurance | Yes |
2021-12-01 | Plan benefit arrangement – Insurance | Yes |
2020: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2020 form 5500 responses |
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2020-12-01 | Type of plan entity | Single employer plan |
2020-12-01 | Submission has been amended | No |
2020-12-01 | This submission is the final filing | No |
2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-12-01 | Plan is a collectively bargained plan | No |
2020-12-01 | Plan funding arrangement – Insurance | Yes |
2020-12-01 | Plan benefit arrangement – Insurance | Yes |
2019: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2019 form 5500 responses |
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2019-12-01 | Type of plan entity | Single employer plan |
2019-12-01 | Submission has been amended | No |
2019-12-01 | This submission is the final filing | No |
2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-12-01 | Plan is a collectively bargained plan | No |
2019-12-01 | Plan funding arrangement – Insurance | Yes |
2019-12-01 | Plan benefit arrangement – Insurance | Yes |
2018: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2018 form 5500 responses |
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2018-12-01 | Type of plan entity | Single employer plan |
2018-12-01 | Submission has been amended | No |
2018-12-01 | This submission is the final filing | No |
2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-12-01 | Plan is a collectively bargained plan | No |
2018-12-01 | Plan funding arrangement – Insurance | Yes |
2018-12-01 | Plan benefit arrangement – Insurance | Yes |
2016: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2016 form 5500 responses |
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2016-12-01 | Type of plan entity | Single employer plan |
2016-12-01 | Submission has been amended | No |
2016-12-01 | This submission is the final filing | No |
2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-12-01 | Plan is a collectively bargained plan | No |
2016-12-01 | Plan funding arrangement – Insurance | Yes |
2016-12-01 | Plan benefit arrangement – Insurance | Yes |
2015: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2015 form 5500 responses |
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2015-12-01 | Type of plan entity | Single employer plan |
2015-12-01 | Submission has been amended | No |
2015-12-01 | This submission is the final filing | No |
2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-12-01 | Plan is a collectively bargained plan | No |
2015-12-01 | Plan funding arrangement – Insurance | Yes |
2015-12-01 | Plan benefit arrangement – Insurance | Yes |
2014: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2014 form 5500 responses |
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2014-12-01 | Type of plan entity | Single employer plan |
2014-12-01 | Submission has been amended | No |
2014-12-01 | This submission is the final filing | No |
2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-12-01 | Plan is a collectively bargained plan | No |
2014-12-01 | Plan funding arrangement – Insurance | Yes |
2014-12-01 | Plan benefit arrangement – Insurance | Yes |
2013: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2013 form 5500 responses |
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2013-12-01 | Type of plan entity | Single employer plan |
2013-12-01 | Submission has been amended | Yes |
2013-12-01 | This submission is the final filing | No |
2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-12-01 | Plan is a collectively bargained plan | No |
2013-12-01 | Plan funding arrangement – Insurance | Yes |
2013-12-01 | Plan benefit arrangement – Insurance | Yes |
2012: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2012 form 5500 responses |
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2012-12-01 | Type of plan entity | Single employer plan |
2012-12-01 | Submission has been amended | Yes |
2012-12-01 | This submission is the final filing | No |
2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-12-01 | Plan is a collectively bargained plan | No |
2012-12-01 | Plan funding arrangement – Insurance | Yes |
2012-12-01 | Plan benefit arrangement – Insurance | Yes |
2011: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2011 form 5500 responses |
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2011-12-01 | Type of plan entity | Single employer plan |
2011-12-01 | Submission has been amended | Yes |
2011-12-01 | This submission is the final filing | No |
2011-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-12-01 | Plan is a collectively bargained plan | No |
2011-12-01 | Plan funding arrangement – Insurance | Yes |
2011-12-01 | Plan benefit arrangement – Insurance | Yes |
2010: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2010 form 5500 responses |
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2010-12-01 | Type of plan entity | Single employer plan |
2010-12-01 | Submission has been amended | Yes |
2010-12-01 | This submission is the final filing | No |
2010-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-12-01 | Plan is a collectively bargained plan | No |
2010-12-01 | Plan funding arrangement – Insurance | Yes |
2010-12-01 | Plan benefit arrangement – Insurance | Yes |
2009: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2009 form 5500 responses |
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2009-12-01 | Type of plan entity | Single employer plan |
2009-12-01 | Submission has been amended | Yes |
2009-12-01 | This submission is the final filing | No |
2009-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-12-01 | Plan is a collectively bargained plan | No |
2009-12-01 | Plan funding arrangement – Insurance | Yes |
2009-12-01 | Plan benefit arrangement – Insurance | Yes |
2008: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2008 form 5500 responses |
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2008-12-01 | Type of plan entity | Single employer plan |
2008-12-01 | Submission has been amended | Yes |
2008-12-01 | This submission is the final filing | No |
2008-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-12-01 | Plan is a collectively bargained plan | No |
2008-12-01 | Plan funding arrangement – Insurance | Yes |
2008-12-01 | Plan benefit arrangement – Insurance | Yes |
2007: DEY APPLIANCE PARTS EMPLOYEE BENEFITS PLAN 2007 form 5500 responses |
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2007-12-01 | Type of plan entity | Single employer plan |
2007-12-01 | First time form 5500 has been submitted | Yes |
2007-12-01 | Submission has been amended | Yes |
2007-12-01 | This submission is the final filing | No |
2007-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2007-12-01 | Plan is a collectively bargained plan | No |
2007-12-01 | Plan funding arrangement – Insurance | Yes |
2007-12-01 | Plan benefit arrangement – Insurance | Yes |
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 928491 |
Policy instance | 2 |
Insurance contract or identification number | 928491 | Number of Individuals Covered | 144 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $19,796 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE, ACCIDENT, CRITICAL ILLNESS | 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 $174,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,796 | Insurance broker organization code? | 3 |
|
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
Policy contract number | 308447 |
Policy instance | 1 |
Insurance contract or identification number | 308447 | Number of Individuals Covered | 105 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $52,507 | 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 $1,312,462 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $52,507 | Insurance broker organization code? | 3 |
|
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
Policy contract number | 308447 |
Policy instance | 1 |
Insurance contract or identification number | 308447 | Number of Individuals Covered | 123 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $58,690 | 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 $1,173,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $58,690 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 928491 |
Policy instance | 2 |
Insurance contract or identification number | 928491 | Number of Individuals Covered | 144 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $18,044 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE & DEPENDENT LIFE, ACCIDENT, CRITICAL ILLNESS | 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 $163,781 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,044 | Insurance broker organization code? | 3 |
|
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
Policy contract number | 308447 |
Policy instance | 1 |
Insurance contract or identification number | 308447 | Number of Individuals Covered | 122 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $54,371 | 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 $1,087,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,371 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 928491 |
Policy instance | 2 |
Insurance contract or identification number | 928491 | Number of Individuals Covered | 138 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $11,869 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE, ACCIDENT, CRITICAL ILLNESS | 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 $110,206 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,869 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 928491 |
Policy instance | 2 |
Insurance contract or identification number | 928491 | Number of Individuals Covered | 141 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $6,727 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE | 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 $59,228 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,727 | Insurance broker organization code? | 3 |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5470729 |
Policy instance | 3 |
Insurance contract or identification number | 5470729 | Number of Individuals Covered | 93 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,992 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE | 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 $70,703 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,992 | Insurance broker organization code? | 3 |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5470729 |
Policy instance | 4 |
Insurance contract or identification number | 5470729 | Number of Individuals Covered | 113 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $3,086 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE | 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 $25,375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,086 | Insurance broker organization code? | 3 |
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MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 ) |
Policy contract number | 308447 |
Policy instance | 1 |
Insurance contract or identification number | 308447 | Number of Individuals Covered | 99 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $40,220 | 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 $804,392 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,220 | Insurance broker organization code? | 3 |
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HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 26138 |
Policy instance | 1 |
Insurance contract or identification number | 26138 | Number of Individuals Covered | 97 | Insurance policy start date | 2014-12-01 | Insurance policy end date | 2015-11-30 | Total amount of commissions paid to insurance broker | USD $34,881 | 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 $692,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,881 | Insurance broker organization code? | 3 | Insurance broker name | MARY BATES-BATES INSURANCE SERVICES |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5470729 |
Policy instance | 2 |
Insurance contract or identification number | 5470729 | Number of Individuals Covered | 114 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $6,885 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE | 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 $64,464 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,885 | Insurance broker organization code? | 3 | Insurance broker name | BATES INSURANCE SERVICES INC DBA BA |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00456152 |
Policy instance | 2 |
Insurance contract or identification number | 00456152 | Number of Individuals Covered | 90 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $6,550 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, OPTIONAL LIFE | 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 $56,617 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,485 | Insurance broker organization code? | 3 | Insurance broker name | FOSTER KILMA CO |
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HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 26138 |
Policy instance | 1 |
Insurance contract or identification number | 26138 | Number of Individuals Covered | 106 | Insurance policy start date | 2013-12-01 | Insurance policy end date | 2014-11-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $36,580 | 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 $735,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 36580 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | MARY BATES |
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HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 26138 |
Policy instance | 1 |
Insurance contract or identification number | 26138 | Number of Individuals Covered | 119 | Insurance policy start date | 2012-12-01 | Insurance policy end date | 2013-11-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $34,078 | 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 $687,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 34078 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | MARY BATES |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00456152 |
Policy instance | 2 |
Insurance contract or identification number | 00456152 | Number of Individuals Covered | 93 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $7,089 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D, OPTIONAL LIFE | 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 $62,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,089 | Insurance broker organization code? | 3 | Insurance broker name | BATES INSURANCE SERVICES INC |
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HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 ) |
Policy contract number | 26138 |
Policy instance | 1 |
Insurance contract or identification number | 26138 | Number of Individuals Covered | 112 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-11-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $30,856 | 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 $639,616 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 30856 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | MARY BATES |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00456152 |
Policy instance | 2 |
Insurance contract or identification number | 00456152 | Number of Individuals Covered | 120 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-11-30 | 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 | 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 | AD&D | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00456152 |
Policy instance | 2 |
Insurance contract or identification number | 00456152 | Number of Individuals Covered | 117 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | 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 | 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 | AD&D | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
Policy contract number | CN402 |
Policy instance | 1 |
Insurance contract or identification number | CN402 | Number of Individuals Covered | 115 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $24,625 | 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 $739,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,625 | Insurance broker organization code? | 3 | Insurance broker name | EDWARD D BATES & ASSOC INC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 101337701 |
Policy instance | 2 |
Insurance contract or identification number | 101337701 | Number of Individuals Covered | 99 | Insurance policy start date | 2009-05-01 | Insurance policy end date | 2010-04-30 | Total amount of commissions paid to insurance broker | USD $849 | 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 | 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 | AD&D | 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 $9,359 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $849 | Insurance broker organization code? | 3 | Insurance broker name | JEREME BATES |
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BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
Policy contract number | CN402 |
Policy instance | 1 |
Insurance contract or identification number | CN402 | Number of Individuals Covered | 121 | Insurance policy start date | 2009-12-01 | Insurance policy end date | 2010-11-30 | Total amount of commissions paid to insurance broker | USD $40,185 | 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 $801,589 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,185 | Insurance broker organization code? | 3 | Insurance broker name | EDWARD D BATES & ASSOC INC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 101337701 |
Policy instance | 2 |
Insurance contract or identification number | 101337701 | Number of Individuals Covered | 95 | Insurance policy start date | 2008-05-01 | Insurance policy end date | 2009-04-30 | Total amount of commissions paid to insurance broker | USD $993 | 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 | 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 | AD&D | 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 $11,545 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $993 | Insurance broker organization code? | 3 | Insurance broker name | JEREME BATES |
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BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
Policy contract number | CN402 |
Policy instance | 1 |
Insurance contract or identification number | CN402 | Number of Individuals Covered | 127 | Insurance policy start date | 2008-12-01 | Insurance policy end date | 2009-11-30 | Total amount of commissions paid to insurance broker | USD $36,055 | 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 $722,107 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,055 | Insurance broker organization code? | 3 | Insurance broker name | EDWARD D BATES & ASSOC INC |
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USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
Policy contract number | 101337701 |
Policy instance | 2 |
Insurance contract or identification number | 101337701 | Number of Individuals Covered | 87 | Insurance policy start date | 2007-05-01 | Insurance policy end date | 2008-04-30 | Total amount of commissions paid to insurance broker | USD $592 | 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 | 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 | AD&D | 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 $6,148 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $592 | Insurance broker organization code? | 3 | Insurance broker name | JEREME BATES |
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BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
Policy contract number | CN402 |
Policy instance | 1 |
Insurance contract or identification number | CN402 | Number of Individuals Covered | 144 | Insurance policy start date | 2007-12-01 | Insurance policy end date | 2008-11-30 | Total amount of commissions paid to insurance broker | USD $34,801 | 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 $696,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,801 | Insurance broker organization code? | 3 | Insurance broker name | EDWARD D BATES & ASSOC INC |
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