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KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 401k Plan overview

Plan NameKLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN
Plan identification number 504

KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

KLINGBEIL CAPITAL MANAGEMENT, LTD. has sponsored the creation of one or more 401k plans.

Company Name:KLINGBEIL CAPITAL MANAGEMENT, LTD.
Employer identification number (EIN):943397989
NAIC Classification:531110
NAIC Description:Lessors of Residential Buildings and Dwellings

Additional information about KLINGBEIL CAPITAL MANAGEMENT, LTD.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 2000-08-24
Company Identification Number: 1177998
Legal Registered Office Address: 21 W. BROAD ST.
11TH FLOOR
COLUMBUS
United States of America (USA)
43215

More information about KLINGBEIL CAPITAL MANAGEMENT, LTD.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-06-01FARON H. LEE, JR.2023-11-13
5042021-06-01
5042020-06-01
5042019-06-01
5042018-06-01
5042017-06-01KEVIN KAZ
5042016-06-01GEORGE NICKERSON GEORGE NICKERSON2017-11-16
5042015-06-01GEORGE NICKERSON GEORGE NICKERSON2016-11-22
5042014-06-01GEORGE NICKERSON GEORGE NICKERSON2015-12-16
5042013-06-01GEORGE NICKERSON GEORGE NICKERSON2014-12-29
5042012-06-01GEORGE NICKERSON GEORGE NICKERSON2014-01-22
5042011-06-01GEORGE NICKERSON GEORGE NICKERSON2012-11-01
5042010-06-01GEORGE NICKERSON GEORGE NICKERSON2011-11-03
5042009-06-01GEORGE NICKERSON GEORGE NICKERSON2010-09-15

Plan Statistics for KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN

401k plan membership statisitcs for KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN

Measure Date Value
2022: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01153
Total number of active participants reported on line 7a of the Form 55002022-06-01143
Total of all active and inactive participants2022-06-01143
2021: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01168
Total number of active participants reported on line 7a of the Form 55002021-06-01153
Total of all active and inactive participants2021-06-01153
Total participants2021-06-01153
2020: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01287
Total number of active participants reported on line 7a of the Form 55002020-06-01168
Total of all active and inactive participants2020-06-01168
Total participants2020-06-01168
2019: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01339
Total number of active participants reported on line 7a of the Form 55002019-06-01287
Total of all active and inactive participants2019-06-01287
Total participants2019-06-01287
2018: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01321
Total number of active participants reported on line 7a of the Form 55002018-06-01339
Total of all active and inactive participants2018-06-01339
Total participants2018-06-01339
2017: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01325
Total number of active participants reported on line 7a of the Form 55002017-06-01321
Total of all active and inactive participants2017-06-01321
Total participants2017-06-01321
2016: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01330
Total number of active participants reported on line 7a of the Form 55002016-06-01325
Total of all active and inactive participants2016-06-01325
Total participants2016-06-01325
2015: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01365
Total number of active participants reported on line 7a of the Form 55002015-06-01330
Total of all active and inactive participants2015-06-01330
Total participants2015-06-01330
2014: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01402
Total number of active participants reported on line 7a of the Form 55002014-06-01365
Total of all active and inactive participants2014-06-01365
Total participants2014-06-01365
2013: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01161
Total number of active participants reported on line 7a of the Form 55002013-06-01402
Total of all active and inactive participants2013-06-01402
Total participants2013-06-01402
2012: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01180
Total number of active participants reported on line 7a of the Form 55002012-06-01161
Total of all active and inactive participants2012-06-01161
Total participants2012-06-01161
2011: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01163
Total number of active participants reported on line 7a of the Form 55002011-06-01180
Total of all active and inactive participants2011-06-01180
Total participants2011-06-01180
2010: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01171
Total number of active participants reported on line 7a of the Form 55002010-06-01163
Total of all active and inactive participants2010-06-01163
2009: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01166
Total number of active participants reported on line 7a of the Form 55002009-06-01171
Total of all active and inactive participants2009-06-01171

Form 5500 Responses for KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN

2022: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Submission has been amendedNo
2022-06-01This submission is the final filingNo
2022-06-01This return/report is a short plan year return/report (less than 12 months)No
2022-06-01Plan is a collectively bargained planNo
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – InsuranceYes
2021: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Submission has been amendedNo
2021-06-01This submission is the final filingNo
2021-06-01This return/report is a short plan year return/report (less than 12 months)No
2021-06-01Plan is a collectively bargained planNo
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Submission has been amendedNo
2020-06-01This submission is the final filingNo
2020-06-01This return/report is a short plan year return/report (less than 12 months)No
2020-06-01Plan is a collectively bargained planNo
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Submission has been amendedNo
2019-06-01This submission is the final filingNo
2019-06-01This return/report is a short plan year return/report (less than 12 months)No
2019-06-01Plan is a collectively bargained planNo
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – General assets of the sponsorYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: KLINGBEIL CAPITAL MANAGEMENT HEALTH PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01This submission is the final filingNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – General assets of the sponsorYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number29656
Policy instance 1
Insurance contract or identification number29656
Number of Individuals Covered143
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $20,330
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,014,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,330
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number29656
Policy instance 1
Insurance contract or identification number29656
Number of Individuals Covered153
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $21,249
Total amount of fees paid to insurance companyUSD $6,052
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,052,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,249
Amount paid for insurance broker fees6052
Additional information about fees paid to insurance brokerANNUAL BOB
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number29656
Policy instance 1
Insurance contract or identification number29656
Number of Individuals Covered168
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $22,645
Total amount of fees paid to insurance companyUSD $3,150
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,120,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,645
Amount paid for insurance broker fees3150
Additional information about fees paid to insurance brokerANNUAL BOB
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0869657
Policy instance 1
Insurance contract or identification number0869657
Number of Individuals Covered287
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $44,447
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,347,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,447
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0869657
Policy instance 1
Insurance contract or identification number0869657
Number of Individuals Covered339
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $42,464
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,103,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,464
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0869657
Policy instance 1
Insurance contract or identification number0869657
Number of Individuals Covered321
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $38,428
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,021,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,428
Insurance broker organization code?3
Insurance broker nameJAMES B OSWALD COMPANY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0869657
Policy instance 1
Insurance contract or identification number0869657
Number of Individuals Covered330
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $33,184
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,747,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,184
Insurance broker organization code?3
Insurance broker nameJAMES B OSWALD COMPANY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754452
Policy instance 1
Insurance contract or identification number754452
Number of Individuals Covered365
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $42,740
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,963,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees38940
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS SPECIALISTS INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754452
Policy instance 1
Insurance contract or identification number754452
Number of Individuals Covered402
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of fees paid to insurance companyUSD $43,460
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,679,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees43460
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS SPECIALISTS INC.
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00170377
Policy instance 1
Insurance contract or identification number00170377
Number of Individuals Covered161
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $55,264
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,689,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,264
Insurance broker organization code?3
Insurance broker nameGROUP BENEFITS SPECIALISTS INC
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00170377
Policy instance 1
Insurance contract or identification number00170377
Number of Individuals Covered180
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $50,484
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,619,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00170377
Policy instance 1
Insurance contract or identification number00170377
Number of Individuals Covered163
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $45,140
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,572,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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