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THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 401k Plan overview

Plan NameTHE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN
Plan identification number 518

THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Vision

401k Sponsoring company profile

THE UNIVERSITY OF CHICAGO MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name:THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Employer identification number (EIN):363488183
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5182022-07-01
5182021-07-01
5182020-07-01
5182019-07-01
5182018-07-01
5182017-07-01
5182016-07-01BOB HANLEY
5182015-07-01BOB HANLEY
5182014-07-01BOB HANLEY
5182013-07-01BOB HANLEY
5182012-07-01BOB HANLEY
5182011-07-01TERRY SOLEM
5182010-07-01TERRY SOLEM
5182009-07-01JOSEPH PULICHENE
5182008-07-01LARRY A. CALLAHAN

Plan Statistics for THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN

401k plan membership statisitcs for THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN

Measure Date Value
2022: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-019,944
Total number of active participants reported on line 7a of the Form 55002022-07-018,738
Number of retired or separated participants receiving benefits2022-07-011,592
Total of all active and inactive participants2022-07-0110,330
2021: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-019,617
Total number of active participants reported on line 7a of the Form 55002021-07-018,436
Number of retired or separated participants receiving benefits2021-07-011,508
Total of all active and inactive participants2021-07-019,944
2020: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-019,496
Total number of active participants reported on line 7a of the Form 55002020-07-017,933
Number of retired or separated participants receiving benefits2020-07-011,684
Total of all active and inactive participants2020-07-019,617
2019: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-016,942
Total number of active participants reported on line 7a of the Form 55002019-07-019,394
Number of retired or separated participants receiving benefits2019-07-01102
Total of all active and inactive participants2019-07-019,496
2018: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-015,150
Total number of active participants reported on line 7a of the Form 55002018-07-016,896
Number of retired or separated participants receiving benefits2018-07-0146
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-016,942
2017: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-014,957
Total number of active participants reported on line 7a of the Form 55002017-07-015,070
Number of retired or separated participants receiving benefits2017-07-0180
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-015,150
2016: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-014,611
Total number of active participants reported on line 7a of the Form 55002016-07-014,899
Number of retired or separated participants receiving benefits2016-07-0158
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-014,957
2015: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-013,730
Total number of active participants reported on line 7a of the Form 55002015-07-014,463
Number of retired or separated participants receiving benefits2015-07-0160
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-014,523
2014: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-013,493
Total number of active participants reported on line 7a of the Form 55002014-07-013,679
Number of retired or separated participants receiving benefits2014-07-0151
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-013,730
2013: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-013,540
Total number of active participants reported on line 7a of the Form 55002013-07-013,453
Number of retired or separated participants receiving benefits2013-07-0140
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-013,493
2012: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-013,285
Total number of active participants reported on line 7a of the Form 55002012-07-013,516
Number of retired or separated participants receiving benefits2012-07-0124
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-013,540
2011: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-013,096
Total number of active participants reported on line 7a of the Form 55002011-07-013,280
Number of retired or separated participants receiving benefits2011-07-0121
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-013,301
2010: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-013,134
Total number of active participants reported on line 7a of the Form 55002010-07-013,119
Number of retired or separated participants receiving benefits2010-07-0129
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-013,148
2009: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-013,136
Total number of active participants reported on line 7a of the Form 55002009-07-013,083
Number of retired or separated participants receiving benefits2009-07-0151
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-013,134
2008: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2008 401k membership
Total participants, beginning-of-year2008-07-013,082
Total number of active participants reported on line 7a of the Form 55002008-07-013,084
Number of retired or separated participants receiving benefits2008-07-0152
Number of other retired or separated participants entitled to future benefits2008-07-010
Total of all active and inactive participants2008-07-013,136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-07-010
Total participants2008-07-013,136
Number of participants with account balances2008-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-07-010
Number of employers contributing to the scheme2008-07-010

Financial Data on THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN

Measure Date Value
2019 : THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2019 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Was this plan covered by a fidelity bond2019-06-30No
If this is an individual account plan, was there a blackout period2019-06-30No
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-06-30No
Did the plan have assets held for investment2019-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No

Form 5500 Responses for THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN

2022: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes
2008: THE UNIVERSITY OF CHICAGO MEDICAL CENTER VISION SERVICE PLAN 2008 form 5500 responses
2008-07-01Type of plan entitySingle employer plan
2008-07-01Submission has been amendedNo
2008-07-01This submission is the final filingNo
2008-07-01This return/report is a short plan year return/report (less than 12 months)No
2008-07-01Plan is a collectively bargained planNo
2008-07-01Plan funding arrangement – InsuranceYes
2008-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered8849
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $44,644
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $845,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,687
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5092
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $14,883
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $273,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,671
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered8668
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $63,730
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $996,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,730
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 number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5007
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $22,262
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $345,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,262
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 number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered8439
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $35,319
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $784,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,319
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5249
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $13,022
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $296,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,022
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered8203
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $42,512
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $750,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,512
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5326
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $17,100
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $282,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,100
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered7167
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $24,456
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $709,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,456
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5390
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $11,372
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $347,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,372
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005895
Policy instance 2
Insurance contract or identification number1005895
Number of Individuals Covered6024
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $20,070
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 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 $417,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number1005894
Policy instance 1
Insurance contract or identification number1005894
Number of Individuals Covered5891
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $12,979
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 $262,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered8886
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $19,361
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $496,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,902
Insurance broker organization code?3
Insurance broker nameGNASTER & GNASTER INC.
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered8551
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $18,838
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $413,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,838
Insurance broker organization code?3
Insurance broker nameGNASTER & GNASTER INC.
NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered7958
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $18,714
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $373,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,714
Insurance broker organization code?3
Insurance broker nameGNASTER & GNASTER INC.
NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered7074
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $22,559
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $390,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,559
Insurance broker organization code?3
Insurance broker nameGNASTER & GNASTER INC.
NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered6472
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $14,984
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $363,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number28780
Policy instance 1
Insurance contract or identification number28780
Number of Individuals Covered6123
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $17,506
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $350,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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