RIDGEWOOD SAVINGS BANK has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: TRAVEL ACCIDENT INSURANCE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-22 | 543 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-22 | 556 |
| Total of all active and inactive participants | 2022-04-22 | 556 |
| Total participants | 2022-04-22 | 556 |
| 2021: TRAVEL ACCIDENT INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-22 | 575 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-22 | 543 |
| Total of all active and inactive participants | 2021-04-22 | 543 |
| Total participants | 2021-04-22 | 543 |
| 2020: TRAVEL ACCIDENT INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-22 | 603 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-22 | 575 |
| Total of all active and inactive participants | 2020-04-22 | 575 |
| Total participants | 2020-04-22 | 575 |
| 2019: TRAVEL ACCIDENT INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-22 | 635 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-22 | 603 |
| Total of all active and inactive participants | 2019-04-22 | 603 |
| Total participants | 2019-04-22 | 603 |
| 2018: TRAVEL ACCIDENT INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-22 | 665 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-22 | 635 |
| Total of all active and inactive participants | 2018-04-22 | 635 |
| Total participants | 2018-04-22 | 635 |
| 2017: TRAVEL ACCIDENT INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-22 | 675 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-22 | 665 |
| Total of all active and inactive participants | 2017-04-22 | 665 |
| Total participants | 2017-04-22 | 665 |
| 2016: TRAVEL ACCIDENT INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-22 | 697 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-22 | 675 |
| Total of all active and inactive participants | 2016-04-22 | 675 |
| Total participants | 2016-04-22 | 675 |
| 2015: TRAVEL ACCIDENT INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-22 | 692 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-22 | 697 |
| Total of all active and inactive participants | 2015-04-22 | 697 |
| Total participants | 2015-04-22 | 697 |
| 2014: TRAVEL ACCIDENT INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-22 | 739 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-22 | 692 |
| Total of all active and inactive participants | 2014-04-22 | 692 |
| Total participants | 2014-04-22 | 692 |
| 2013: TRAVEL ACCIDENT INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-22 | 739 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-22 | 739 |
| Total of all active and inactive participants | 2013-04-22 | 739 |
| Total participants | 2013-04-22 | 739 |
| 2012: TRAVEL ACCIDENT INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-22 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-22 | 7 |
| Total of all active and inactive participants | 2012-04-22 | 7 |
| Total participants | 2012-04-22 | 7 |
| 2011: TRAVEL ACCIDENT INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-22 | 764 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-22 | 766 |
| Total of all active and inactive participants | 2011-04-22 | 766 |
| Total participants | 2011-04-22 | 766 |
| 2009: TRAVEL ACCIDENT INSURANCE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-22 | 803 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-22 | 791 |
| Total of all active and inactive participants | 2009-04-22 | 791 |
| Total participants | 2009-04-22 | 791 |
| 2022: TRAVEL ACCIDENT INSURANCE 2022 form 5500 responses |
|---|
| 2022-04-22 | Type of plan entity | Single employer plan |
| 2022-04-22 | Submission has been amended | No |
| 2022-04-22 | This submission is the final filing | No |
| 2022-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-22 | Plan is a collectively bargained plan | No |
| 2022-04-22 | Plan funding arrangement – Insurance | Yes |
| 2022-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2021: TRAVEL ACCIDENT INSURANCE 2021 form 5500 responses |
|---|
| 2021-04-22 | Type of plan entity | Single employer plan |
| 2021-04-22 | Submission has been amended | No |
| 2021-04-22 | This submission is the final filing | No |
| 2021-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-04-22 | Plan is a collectively bargained plan | No |
| 2021-04-22 | Plan funding arrangement – Insurance | Yes |
| 2021-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2020: TRAVEL ACCIDENT INSURANCE 2020 form 5500 responses |
|---|
| 2020-04-22 | Type of plan entity | Single employer plan |
| 2020-04-22 | Submission has been amended | No |
| 2020-04-22 | This submission is the final filing | No |
| 2020-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-04-22 | Plan is a collectively bargained plan | No |
| 2020-04-22 | Plan funding arrangement – Insurance | Yes |
| 2020-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2019: TRAVEL ACCIDENT INSURANCE 2019 form 5500 responses |
|---|
| 2019-04-22 | Type of plan entity | Single employer plan |
| 2019-04-22 | Submission has been amended | No |
| 2019-04-22 | This submission is the final filing | No |
| 2019-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-04-22 | Plan is a collectively bargained plan | No |
| 2019-04-22 | Plan funding arrangement – Insurance | Yes |
| 2019-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2018: TRAVEL ACCIDENT INSURANCE 2018 form 5500 responses |
|---|
| 2018-04-22 | Type of plan entity | Single employer plan |
| 2018-04-22 | Submission has been amended | Yes |
| 2018-04-22 | This submission is the final filing | No |
| 2018-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-04-22 | Plan is a collectively bargained plan | No |
| 2018-04-22 | Plan funding arrangement – Insurance | Yes |
| 2018-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2017: TRAVEL ACCIDENT INSURANCE 2017 form 5500 responses |
|---|
| 2017-04-22 | Type of plan entity | Single employer plan |
| 2017-04-22 | Submission has been amended | Yes |
| 2017-04-22 | This submission is the final filing | No |
| 2017-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-04-22 | Plan is a collectively bargained plan | No |
| 2017-04-22 | Plan funding arrangement – Insurance | Yes |
| 2017-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2016: TRAVEL ACCIDENT INSURANCE 2016 form 5500 responses |
|---|
| 2016-04-22 | Type of plan entity | Single employer plan |
| 2016-04-22 | Submission has been amended | Yes |
| 2016-04-22 | This submission is the final filing | No |
| 2016-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-04-22 | Plan is a collectively bargained plan | No |
| 2016-04-22 | Plan funding arrangement – Insurance | Yes |
| 2016-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2015: TRAVEL ACCIDENT INSURANCE 2015 form 5500 responses |
|---|
| 2015-04-22 | Type of plan entity | Single employer plan |
| 2015-04-22 | Submission has been amended | Yes |
| 2015-04-22 | This submission is the final filing | No |
| 2015-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-04-22 | Plan is a collectively bargained plan | No |
| 2015-04-22 | Plan funding arrangement – Insurance | Yes |
| 2015-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2014: TRAVEL ACCIDENT INSURANCE 2014 form 5500 responses |
|---|
| 2014-04-22 | Type of plan entity | Single employer plan |
| 2014-04-22 | Submission has been amended | Yes |
| 2014-04-22 | This submission is the final filing | No |
| 2014-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-04-22 | Plan is a collectively bargained plan | No |
| 2014-04-22 | Plan funding arrangement – Insurance | Yes |
| 2014-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2013: TRAVEL ACCIDENT INSURANCE 2013 form 5500 responses |
|---|
| 2013-04-22 | Type of plan entity | Single employer plan |
| 2013-04-22 | Submission has been amended | Yes |
| 2013-04-22 | This submission is the final filing | No |
| 2013-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-04-22 | Plan is a collectively bargained plan | No |
| 2013-04-22 | Plan funding arrangement – Insurance | Yes |
| 2013-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2012: TRAVEL ACCIDENT INSURANCE 2012 form 5500 responses |
|---|
| 2012-04-22 | Type of plan entity | Single employer plan |
| 2012-04-22 | Submission has been amended | No |
| 2012-04-22 | This submission is the final filing | No |
| 2012-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-04-22 | Plan is a collectively bargained plan | No |
| 2012-04-22 | Plan funding arrangement – Insurance | Yes |
| 2012-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2011: TRAVEL ACCIDENT INSURANCE 2011 form 5500 responses |
|---|
| 2011-04-22 | Type of plan entity | Single employer plan |
| 2011-04-22 | Submission has been amended | No |
| 2011-04-22 | This submission is the final filing | No |
| 2011-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-04-22 | Plan is a collectively bargained plan | No |
| 2011-04-22 | Plan funding arrangement – Insurance | Yes |
| 2011-04-22 | Plan benefit arrangement – Insurance | Yes |
| 2009: TRAVEL ACCIDENT INSURANCE 2009 form 5500 responses |
|---|
| 2009-04-22 | Type of plan entity | Single employer plan |
| 2009-04-22 | Submission has been amended | No |
| 2009-04-22 | This submission is the final filing | No |
| 2009-04-22 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-04-22 | Plan is a collectively bargained plan | No |
| 2009-04-22 | Plan funding arrangement – Insurance | Yes |
| 2009-04-22 | Plan benefit arrangement – Insurance | Yes |
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | N04248478 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2022-04-22 | | Insurance policy end date | 2023-04-21 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | N04248478 | | Number of Individuals Covered | 543 | | Insurance policy start date | 2021-04-22 | | Insurance policy end date | 2022-04-21 | | Total amount of commissions paid to insurance broker | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADDN04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADDN04248478 | | Number of Individuals Covered | 575 | | Insurance policy start date | 2020-04-22 | | Insurance policy end date | 2021-04-21 | | Total amount of commissions paid to insurance broker | USD $1,936 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,936 | | Additional information about fees paid to insurance broker | SERVICES |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 603 | | Insurance policy start date | 2019-04-22 | | Insurance policy end date | 2020-04-21 | | Total amount of commissions paid to insurance broker | USD $646 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $646 | | Additional information about fees paid to insurance broker | SERVICES |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 635 | | Insurance policy start date | 2018-04-22 | | Insurance policy end date | 2019-04-21 | | Total amount of commissions paid to insurance broker | USD $646 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $646 | | Additional information about fees paid to insurance broker | SERVICES |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 665 | | Insurance policy start date | 2017-04-22 | | Insurance policy end date | 2018-04-21 | | Total amount of commissions paid to insurance broker | USD $646 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $646 | | Additional information about fees paid to insurance broker | SERVICES | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 697 | | Insurance policy start date | 2015-04-22 | | Insurance policy end date | 2016-04-21 | | Total amount of commissions paid to insurance broker | USD $672 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $672 | | Additional information about fees paid to insurance broker | SERVICES | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 692 | | Insurance policy start date | 2014-04-22 | | Insurance policy end date | 2015-04-21 | | Total amount of commissions paid to insurance broker | USD $672 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $672 | | Additional information about fees paid to insurance broker | SERVICES | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 739 | | Insurance policy start date | 2013-04-22 | | Insurance policy end date | 2014-04-21 | | Total amount of commissions paid to insurance broker | USD $656 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | DEATH BENEFIT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $656 | | Additional information about fees paid to insurance broker | SERVICES | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 761 | | Insurance policy start date | 2012-04-22 | | Insurance policy end date | 2013-04-21 | | Total amount of commissions paid to insurance broker | USD $656 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEATH BENEFIT | | Welfare Benefit Premiums Paid to Carrier | USD $3,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $656 | | Additional information about fees paid to insurance broker | SERVICES | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N04248478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N04248478 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2011-04-22 | | Insurance policy end date | 2012-04-21 | | Total amount of commissions paid to insurance broker | USD $1,966 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEATH BENEFIT | | Welfare Benefit Premiums Paid to Carrier | USD $9,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 ) |
| Policy contract number | ADD N0428478 |
| Policy instance | 1 |
| Insurance contract or identification number | ADD N0428478 | | Number of Individuals Covered | 764 | | Insurance policy start date | 2010-04-22 | | Insurance policy end date | 2011-04-21 | | Total amount of commissions paid to insurance broker | USD $1,966 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEATH BENEFIT | | Welfare Benefit Premiums Paid to Carrier | USD $9,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
