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VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 401k Plan overview

Plan NameVALLARTA SUPER MARKETS WELFARE BENEFITS PLAN
Plan identification number 501

VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

DANIEL FOODS ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name:DANIEL FOODS ENTERPRISES, INC.
Employer identification number (EIN):954602362
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01LIZ LLAMAS2023-04-05
5012020-11-01LIZ LLAMAS2022-03-29
5012019-11-01LIZ LLAMAS2021-07-08
5012018-11-01LIZ LLAMAS2020-05-13
5012017-11-01
5012016-11-01LIZ LLAMAS
5012015-11-01LIZ LLAMAS
5012014-11-01HOWARD KAMINSKY2016-05-11 HOWARD KAMINSKY2016-05-11
5012013-11-01HOWARD KAMINSKY2015-06-02 HOWARD KAMINSKY2015-06-02
5012012-11-01JOHN MARQUIS
5012011-11-01JOHN MARQUIS
5012010-11-01JOHN MARQUIS
5012009-11-01JOHN MARQUIS
5012009-11-01JOHN MARQUIS
5012008-11-01JOHN MARQUIS
5012007-11-01JOHN MARQUIS
5012006-11-01JOHN MARQUIS

Plan Statistics for VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN

401k plan membership statisitcs for VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN

Measure Date Value
2021: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-011,119
Total number of active participants reported on line 7a of the Form 55002021-11-011,043
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-011,043
Number of employers contributing to the scheme2021-11-010
2020: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-011,190
Total number of active participants reported on line 7a of the Form 55002020-11-011,119
Number of retired or separated participants receiving benefits2020-11-010
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-011,119
Number of employers contributing to the scheme2020-11-010
2019: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-013,404
Total number of active participants reported on line 7a of the Form 55002019-11-011,190
Number of retired or separated participants receiving benefits2019-11-010
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-011,190
Number of employers contributing to the scheme2019-11-010
2018: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-013,454
Total number of active participants reported on line 7a of the Form 55002018-11-013,404
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-013,404
Number of employers contributing to the scheme2018-11-010
2017: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-013,809
Total number of active participants reported on line 7a of the Form 55002017-11-013,454
Total of all active and inactive participants2017-11-013,454
Total participants2017-11-013,454
2016: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-013,654
Total number of active participants reported on line 7a of the Form 55002016-11-013,809
Total of all active and inactive participants2016-11-013,809
Total participants2016-11-013,809
2015: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-013,526
Total number of active participants reported on line 7a of the Form 55002015-11-013,653
Number of retired or separated participants receiving benefits2015-11-011
Total of all active and inactive participants2015-11-013,654
Total participants2015-11-013,654
2014: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-013,294
Total number of active participants reported on line 7a of the Form 55002014-11-013,526
Total of all active and inactive participants2014-11-013,526
Total participants2014-11-013,526
2013: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-011,843
Total number of active participants reported on line 7a of the Form 55002013-11-013,294
Total of all active and inactive participants2013-11-013,294
Total participants2013-11-013,294
2012: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-011,461
Total number of active participants reported on line 7a of the Form 55002012-11-011,843
Total of all active and inactive participants2012-11-011,843
Total participants2012-11-011,843
2011: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-011,420
Total number of active participants reported on line 7a of the Form 55002011-11-011,461
Number of retired or separated participants receiving benefits2011-11-012
Number of other retired or separated participants entitled to future benefits2011-11-0161
Total of all active and inactive participants2011-11-011,524
2010: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-011,141
Total number of active participants reported on line 7a of the Form 55002010-11-011,417
Number of retired or separated participants receiving benefits2010-11-013
Number of other retired or separated participants entitled to future benefits2010-11-010
Total of all active and inactive participants2010-11-011,420
2009: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-011,348
Total number of active participants reported on line 7a of the Form 55002009-11-011,135
Number of retired or separated participants receiving benefits2009-11-016
Number of other retired or separated participants entitled to future benefits2009-11-010
Total of all active and inactive participants2009-11-011,141
2008: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-11-011,287
Total number of active participants reported on line 7a of the Form 55002008-11-011,340
Number of retired or separated participants receiving benefits2008-11-018
Number of other retired or separated participants entitled to future benefits2008-11-010
Total of all active and inactive participants2008-11-011,348
2007: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year2007-11-01990
Total number of active participants reported on line 7a of the Form 55002007-11-011,284
Number of retired or separated participants receiving benefits2007-11-013
Number of other retired or separated participants entitled to future benefits2007-11-010
Total of all active and inactive participants2007-11-011,287
2006: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year2006-11-01900
Total number of active participants reported on line 7a of the Form 55002006-11-01989
Number of retired or separated participants receiving benefits2006-11-011
Number of other retired or separated participants entitled to future benefits2006-11-010
Total of all active and inactive participants2006-11-01990

Form 5500 Responses for VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN

2021: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – InsuranceYes
2020: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – InsuranceYes
2019: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2018: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2015: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes
2014: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes
2012: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – InsuranceYes
2011: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – InsuranceYes
2010: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedYes
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – InsuranceYes
2009: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – InsuranceYes
2008: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2008 form 5500 responses
2008-11-01Type of plan entitySingle employer plan
2008-11-01Submission has been amendedYes
2008-11-01This submission is the final filingNo
2008-11-01This return/report is a short plan year return/report (less than 12 months)No
2008-11-01Plan is a collectively bargained planNo
2008-11-01Plan funding arrangement – InsuranceYes
2008-11-01Plan benefit arrangement – InsuranceYes
2007: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2007 form 5500 responses
2007-11-01Type of plan entitySingle employer plan
2007-11-01Submission has been amendedYes
2007-11-01This submission is the final filingNo
2007-11-01This return/report is a short plan year return/report (less than 12 months)No
2007-11-01Plan is a collectively bargained planNo
2007-11-01Plan funding arrangement – InsuranceYes
2007-11-01Plan benefit arrangement – InsuranceYes
2006: VALLARTA SUPER MARKETS WELFARE BENEFITS PLAN 2006 form 5500 responses
2006-11-01Type of plan entitySingle employer plan
2006-11-01Submission has been amendedYes
2006-11-01This submission is the final filingNo
2006-11-01This return/report is a short plan year return/report (less than 12 months)No
2006-11-01Plan is a collectively bargained planNo
2006-11-01Plan funding arrangement – InsuranceYes
2006-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD132207
Policy instance 2
Insurance contract or identification numberLTD132207
Number of Individuals Covered162
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $5,444
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $45,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,444
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1847
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $342,306
Total amount of fees paid to insurance companyUSD $55,344
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $9,793,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $342,306
Amount paid for insurance broker fees24158
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD132207
Policy instance 2
Insurance contract or identification numberLTD132207
Number of Individuals Covered165
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $5,449
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $45,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,449
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1752
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $273,474
Total amount of fees paid to insurance companyUSD $37,147
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $8,007,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $273,474
Amount paid for insurance broker fees8615
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD132207
Policy instance 2
Insurance contract or identification numberLTD132207
Number of Individuals Covered163
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $4,978
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,978
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1845
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $299,737
Total amount of fees paid to insurance companyUSD $27,253
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,696,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $299,749
Amount paid for insurance broker fees6765
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880357G
Policy instance 2
Insurance contract or identification number880357G
Number of Individuals Covered159
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $4,294
Total amount of fees paid to insurance companyUSD $1,262
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,294
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1962
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $320,234
Total amount of fees paid to insurance companyUSD $11,977
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,356,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $320,174
Amount paid for insurance broker fees6534
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880357G
Policy instance 2
Insurance contract or identification number880357G
Number of Individuals Covered144
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $4,092
Total amount of fees paid to insurance companyUSD $981
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,092
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1978
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $288,728
Total amount of fees paid to insurance companyUSD $5,223
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,152,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $265,231
Amount paid for insurance broker fees5223
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880357G
Policy instance 2
Insurance contract or identification number880357G
Number of Individuals Covered13
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $4,070
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $41,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC23902
Policy instance 1
Insurance contract or identification numberC23902
Number of Individuals Covered1259
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $266,047
Total amount of fees paid to insurance companyUSD $63,112
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 $8,354,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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