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HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 401k Plan overview

Plan NameHOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.
Plan identification number 501

HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 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)

401k Sponsoring company profile

NEWCOMB SPRING CORP. has sponsored the creation of one or more 401k plans.

Company Name:NEWCOMB SPRING CORP.
Employer identification number (EIN):060672947
NAIC Classification:332610

Additional information about NEWCOMB SPRING CORP.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1988-10-03
Company Identification Number: 0007783906
Legal Registered Office Address: 3155 NORTH POINT PKWY STE G220

ALPHARETTA
United States of America (USA)
30005

More information about NEWCOMB SPRING CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01BECKY CHRISTENSEN2023-09-27
5012021-04-01BECKY CHRISTENSEN2022-12-07
5012020-04-01BECKY CHRISTENSEN2021-09-01
5012019-04-01BECKY CHRISTENSEN2020-09-08
5012018-04-01BECKY CHRISTENSEN2020-01-13
5012017-04-01BECKY CHRISTENSEN2020-01-13
5012016-04-01JOHN C PORTER
5012015-04-01JOHN C PORTER
5012014-04-01JOHN C PORTER
5012013-04-01JOHN C PORTER
5012012-04-01DAVID DUBROW DAVID DUBROW2013-04-29
5012011-04-01DAVID DUBROW
5012010-04-01DAVID DUBROW
5012009-04-01DAVID DUBROW

Plan Statistics for HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.

401k plan membership statisitcs for HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.

Measure Date Value
2022: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2022 401k membership
Total participants, beginning-of-year2022-04-01185
Total number of active participants reported on line 7a of the Form 55002022-04-01182
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01182
Number of employers contributing to the scheme2022-04-010
2021: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2021 401k membership
Total participants, beginning-of-year2021-04-01164
Total number of active participants reported on line 7a of the Form 55002021-04-01185
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01185
Number of employers contributing to the scheme2021-04-010
2020: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2020 401k membership
Total participants, beginning-of-year2020-04-01188
Total number of active participants reported on line 7a of the Form 55002020-04-01164
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01164
Number of employers contributing to the scheme2020-04-010
2019: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2019 401k membership
Total participants, beginning-of-year2019-04-01210
Total number of active participants reported on line 7a of the Form 55002019-04-01188
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01188
Number of employers contributing to the scheme2019-04-010
2018: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2018 401k membership
Total participants, beginning-of-year2018-04-01207
Total number of active participants reported on line 7a of the Form 55002018-04-01210
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01210
Number of employers contributing to the scheme2018-04-010
2017: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2017 401k membership
Total participants, beginning-of-year2017-04-01197
Total number of active participants reported on line 7a of the Form 55002017-04-01197
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01197
Number of employers contributing to the scheme2017-04-010
2016: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2016 401k membership
Total participants, beginning-of-year2016-04-01201
Total number of active participants reported on line 7a of the Form 55002016-04-01197
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01197
2015: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2015 401k membership
Total participants, beginning-of-year2015-04-01182
Total number of active participants reported on line 7a of the Form 55002015-04-01201
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01201
2014: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2014 401k membership
Total participants, beginning-of-year2014-04-01185
Total number of active participants reported on line 7a of the Form 55002014-04-01182
Number of retired or separated participants receiving benefits2014-04-010
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01182
2013: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2013 401k membership
Total participants, beginning-of-year2013-04-01145
Total number of active participants reported on line 7a of the Form 55002013-04-01185
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01185
2012: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2012 401k membership
Total participants, beginning-of-year2012-04-01179
Total number of active participants reported on line 7a of the Form 55002012-04-01185
Number of retired or separated participants receiving benefits2012-04-011
Total of all active and inactive participants2012-04-01186
Total participants2012-04-01186
2011: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2011 401k membership
Total participants, beginning-of-year2011-04-01171
Total number of active participants reported on line 7a of the Form 55002011-04-01179
Total of all active and inactive participants2011-04-01179
Total participants2011-04-01179
2010: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2010 401k membership
Total participants, beginning-of-year2010-04-01171
Total number of active participants reported on line 7a of the Form 55002010-04-01171
Total of all active and inactive participants2010-04-01171
Total participants2010-04-01171
2009: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2009 401k membership
Total participants, beginning-of-year2009-04-01184
Total number of active participants reported on line 7a of the Form 55002009-04-01173
Total of all active and inactive participants2009-04-01173
Total participants2009-04-01173

Financial Data on HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.

Measure Date Value
2012 : HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-03-31$237,782
Total income from all sources (including contributions)2012-03-31$22,493
Total of all expenses incurred2012-03-31$22,493
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-03-31$21,332
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-03-31$22,493
Value of total assets at end of year2012-03-31$0
Value of total assets at beginning of year2012-03-31$237,782
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-03-31$1,161
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-03-31No
Was this plan covered by a fidelity bond2012-03-31Yes
Value of fidelity bond cover2012-03-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2012-03-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-03-31$9,830
Liabilities. Value of operating payables at end of year2012-03-31$0
Liabilities. Value of operating payables at beginning of year2012-03-31$11,323
Total non interest bearing cash at end of year2012-03-31$0
Total non interest bearing cash at beginning of year2012-03-31$143,118
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Value of net income/loss2012-03-31$0
Value of net assets at end of year (total assets less liabilities)2012-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-03-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-03-31No
Were any leases to which the plan was party in default or uncollectible2012-03-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-03-31No
Was there a failure to transmit to the plan any participant contributions2012-03-31No
Has the plan failed to provide any benefit when due under the plan2012-03-31No
Contributions received in cash from employer2012-03-31$22,493
Employer contributions (assets) at end of year2012-03-31$0
Employer contributions (assets) at beginning of year2012-03-31$84,834
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-03-31$21,332
Contract administrator fees2012-03-31$1,161
Liabilities. Value of benefit claims payable at end of year2012-03-31$0
Liabilities. Value of benefit claims payable at beginning of year2012-03-31$226,459
Did the plan have assets held for investment2012-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-03-31No
Opinion of an independent qualified public accountant for this plan2012-03-31Unqualified
Accountancy firm name2012-03-31AMBER CASCIO AND COMPANY
Accountancy firm EIN2012-03-31061271610
2011 : HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-03-31$237,782
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-03-31$201,600
Total income from all sources (including contributions)2011-03-31$2,102,369
Total of all expenses incurred2011-03-31$2,102,369
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-03-31$2,054,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-03-31$1,846,560
Value of total assets at end of year2011-03-31$237,782
Value of total assets at beginning of year2011-03-31$201,600
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-03-31$48,154
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-03-31No
Was this plan covered by a fidelity bond2011-03-31Yes
Value of fidelity bond cover2011-03-31$500,000
Were there any nonexempt tranactions with any party-in-interest2011-03-31No
Contributions received from participants2011-03-31$393,107
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-03-31$9,830
Other income not declared elsewhere2011-03-31$255,809
Liabilities. Value of operating payables at end of year2011-03-31$11,323
Liabilities. Value of operating payables at beginning of year2011-03-31$9,600
Total non interest bearing cash at end of year2011-03-31$143,118
Total non interest bearing cash at beginning of year2011-03-31$111,011
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Value of net income/loss2011-03-31$0
Value of net assets at end of year (total assets less liabilities)2011-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2011-03-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-03-31No
Were any leases to which the plan was party in default or uncollectible2011-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-03-31$320,893
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-03-31No
Was there a failure to transmit to the plan any participant contributions2011-03-31No
Has the plan failed to provide any benefit when due under the plan2011-03-31No
Contributions received in cash from employer2011-03-31$1,453,453
Employer contributions (assets) at end of year2011-03-31$84,834
Employer contributions (assets) at beginning of year2011-03-31$90,589
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-03-31$1,733,322
Contract administrator fees2011-03-31$48,154
Liabilities. Value of benefit claims payable at end of year2011-03-31$226,459
Liabilities. Value of benefit claims payable at beginning of year2011-03-31$192,000
Did the plan have assets held for investment2011-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-03-31No
Opinion of an independent qualified public accountant for this plan2011-03-31Unqualified
Accountancy firm name2011-03-31AMBER CASCIO AND COMPANY
Accountancy firm EIN2011-03-31061271610

Form 5500 Responses for HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP.

2022: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – TrustYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement - TrustYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2010: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedYes
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – TrustYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement - TrustYes
2009: HOSPITAL AND MEDICAL BENEFIT PLAN FOR EMPLOYEES OF NEWCOMB SPRING CORP. 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – TrustYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered182
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $25,637
Total amount of fees paid to insurance companyUSD $347
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $200,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,637
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered207
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $1,256
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,256
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered185
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $26,355
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $207,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,355
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered190
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $1,234
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,234
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered164
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $23,886
Total amount of fees paid to insurance companyUSD $249
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $187,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,886
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered183
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,165
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,165
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered184
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,150
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,150
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered188
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $13,242
Total amount of fees paid to insurance companyUSD $2,197
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $88,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,242
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered177
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,104
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,104
Amount paid for insurance broker fees0
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered207
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $14,880
Total amount of fees paid to insurance companyUSD $120
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $99,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,880
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10057361001
Policy instance 1
Insurance contract or identification number10057361001
Number of Individuals Covered187
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,132
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10189002
Policy instance 2
Insurance contract or identification number10189002
Number of Individuals Covered210
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $15,392
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $102,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 3086 )
Policy contract numberUNI-201711
Policy instance 4
Insurance contract or identification numberUNI-201711
Number of Individuals Covered145
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $51,830
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 $296,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,830
Insurance broker organization code?3
Insurance broker nameHEALTHGRAM INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number068312
Policy instance 3
Insurance contract or identification number068312
Number of Individuals Covered46
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $3,152
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 $24,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,152
Insurance broker organization code?3
Insurance broker nameSTERLING RISK ADVISORS INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number068312
Policy instance 2
Insurance contract or identification number068312
Number of Individuals Covered187
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $3,723
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 BenefitYes
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 $62,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,723
Insurance broker organization code?3
Insurance broker nameSTERLING RISK ADVISORS INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS7070
Policy instance 1
Insurance contract or identification numberVS7070
Number of Individuals Covered60
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $684
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 BenefitYes
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 $7,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $684
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA

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