NUCLEAR FUEL SERVICES, INC. C/O COMPENSATION & BENEFITS DEPT. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH PLAN FOR SALARIED EMPLOYEES
| Measure | Date | Value |
|---|
| 2022 : HEALTH PLAN FOR SALARIED EMPLOYEES 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $1,626,530 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $1,064,832 |
| Total income from all sources (including contributions) | 2022-12-31 | $4,509,323 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $12,920,838 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $12,226,244 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $10,908,002 |
| Value of total assets at end of year | 2022-12-31 | $40,448,214 |
| Value of total assets at beginning of year | 2022-12-31 | $48,298,031 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $694,594 |
| Total interest from all sources | 2022-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $1,100,417 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $1,100,417 |
| Administrative expenses professional fees incurred | 2022-12-31 | $59,191 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | Yes |
| Amount of non-exempt transactions with any party-in-interest | 2022-12-31 | $281,488 |
| Contributions received from participants | 2022-12-31 | $2,476,333 |
| Participant contributions at end of year | 2022-12-31 | $100,545 |
| Participant contributions at beginning of year | 2022-12-31 | $59,179 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $94,116 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $88,441 |
| Other income not declared elsewhere | 2022-12-31 | $194 |
| Administrative expenses (other) incurred | 2022-12-31 | $530,940 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $281,058 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $139,500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-8,411,515 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $38,821,684 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $47,233,199 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $52,311 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $40,253,553 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $48,150,411 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $1,984,814 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-7,499,290 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $8,431,669 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $10,241,430 |
| Contract administrator fees | 2022-12-31 | $52,152 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $1,345,472 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $925,332 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2022-12-31 | 841656069 |
| 2021 : HEALTH PLAN FOR SALARIED EMPLOYEES 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,064,832 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $908,711 |
| Total income from all sources (including contributions) | 2021-12-31 | $14,515,517 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $12,997,585 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $12,208,727 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $11,469,987 |
| Value of total assets at end of year | 2021-12-31 | $48,298,031 |
| Value of total assets at beginning of year | 2021-12-31 | $46,623,978 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $788,858 |
| Total interest from all sources | 2021-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $778,802 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $778,802 |
| Administrative expenses professional fees incurred | 2021-12-31 | $57,408 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $2,355,188 |
| Participant contributions at end of year | 2021-12-31 | $59,179 |
| Participant contributions at beginning of year | 2021-12-31 | $31,104 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $88,441 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $89,289 |
| Administrative expenses (other) incurred | 2021-12-31 | $638,255 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $139,500 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $175,278 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $1,517,932 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $47,233,199 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $45,715,267 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $48,237 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $48,150,411 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $46,503,585 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $1,833,228 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $2,266,728 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $9,114,799 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $10,375,499 |
| Contract administrator fees | 2021-12-31 | $44,958 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $925,332 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $733,433 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2021-12-31 | 841656069 |
| 2020 : HEALTH PLAN FOR SALARIED EMPLOYEES 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $908,711 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $954,405 |
| Total income from all sources (including contributions) | 2020-12-31 | $16,141,042 |
| Total loss/gain on sale of assets | 2020-12-31 | $0 |
| Total of all expenses incurred | 2020-12-31 | $12,247,886 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $11,626,358 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $10,859,026 |
| Value of total assets at end of year | 2020-12-31 | $46,623,978 |
| Value of total assets at beginning of year | 2020-12-31 | $42,776,516 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $621,528 |
| Total interest from all sources | 2020-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $950,369 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $950,369 |
| Administrative expenses professional fees incurred | 2020-12-31 | $57,109 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $2,254,029 |
| Participant contributions at end of year | 2020-12-31 | $31,104 |
| Participant contributions at beginning of year | 2020-12-31 | $27,478 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $89,289 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $98,519 |
| Administrative expenses (other) incurred | 2020-12-31 | $473,063 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $175,278 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $30,182 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $3,893,156 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $45,715,267 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $41,822,111 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $48,174 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $46,503,585 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $42,650,519 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $1,895,258 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $4,331,647 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $8,604,997 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $9,731,100 |
| Contract administrator fees | 2020-12-31 | $43,182 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $733,433 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $924,223 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Disclaimer |
| Accountancy firm name | 2020-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2020-12-31 | 841656069 |
| 2019 : HEALTH PLAN FOR SALARIED EMPLOYEES 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $954,405 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $893,746 |
| Total income from all sources (including contributions) | 2019-12-31 | $15,150,088 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total of all expenses incurred | 2019-12-31 | $10,902,252 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $10,272,267 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $9,356,668 |
| Value of total assets at end of year | 2019-12-31 | $42,776,516 |
| Value of total assets at beginning of year | 2019-12-31 | $38,468,021 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $629,985 |
| Total interest from all sources | 2019-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $1,118,645 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $1,118,645 |
| Administrative expenses professional fees incurred | 2019-12-31 | $96,023 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $2,161,446 |
| Participant contributions at end of year | 2019-12-31 | $27,478 |
| Participant contributions at beginning of year | 2019-12-31 | $21,106 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $98,519 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $99,731 |
| Other income not declared elsewhere | 2019-12-31 | $396 |
| Administrative expenses (other) incurred | 2019-12-31 | $425,728 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $30,182 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $27,151 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $4,247,836 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $41,822,111 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $37,574,275 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $78,018 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $42,650,519 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $37,309,936 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $1,037,248 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $1,037,248 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,883,219 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $4,674,379 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $7,195,222 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $8,389,048 |
| Contract administrator fees | 2019-12-31 | $30,216 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $924,223 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $866,595 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Accountancy firm name | 2019-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2019-12-31 | 841656069 |
| 2018 : HEALTH PLAN FOR SALARIED EMPLOYEES 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $893,746 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $904,464 |
| Total income from all sources (including contributions) | 2018-12-31 | $10,716,437 |
| Total loss/gain on sale of assets | 2018-12-31 | $0 |
| Total of all expenses incurred | 2018-12-31 | $12,350,594 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $11,900,823 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $11,297,443 |
| Value of total assets at end of year | 2018-12-31 | $38,468,021 |
| Value of total assets at beginning of year | 2018-12-31 | $40,112,896 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $449,771 |
| Total interest from all sources | 2018-12-31 | $26,161 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $997,000 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $997,000 |
| Administrative expenses professional fees incurred | 2018-12-31 | $18,000 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $1,895,924 |
| Participant contributions at end of year | 2018-12-31 | $21,106 |
| Participant contributions at beginning of year | 2018-12-31 | $15,643 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $99,731 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $107,142 |
| Other income not declared elsewhere | 2018-12-31 | $5,479 |
| Administrative expenses (other) incurred | 2018-12-31 | $380,381 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $27,151 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $146,386 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-1,634,157 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $37,574,275 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $39,208,432 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Investment advisory and management fees | 2018-12-31 | $26,951 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $37,309,936 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $38,546,546 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $1,037,248 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $1,443,565 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $1,443,565 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $26,161 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $1,945,628 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-12-31 | $-1,609,646 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $9,401,519 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $9,955,195 |
| Contract administrator fees | 2018-12-31 | $24,439 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $866,595 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $758,078 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Disclaimer |
| Accountancy firm name | 2018-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2018-12-31 | 841656069 |
| 2017 : HEALTH PLAN FOR SALARIED EMPLOYEES 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $904,464 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $2,010,685 |
| Total income from all sources (including contributions) | 2017-12-31 | $15,570,478 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $11,532,215 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $11,050,280 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $10,987,159 |
| Value of total assets at end of year | 2017-12-31 | $40,112,896 |
| Value of total assets at beginning of year | 2017-12-31 | $37,180,854 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $481,935 |
| Total interest from all sources | 2017-12-31 | $11,845 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $831,298 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $831,298 |
| Administrative expenses professional fees incurred | 2017-12-31 | $57,000 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $1,758,070 |
| Participant contributions at end of year | 2017-12-31 | $15,643 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $107,142 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $114,386 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $507,297 |
| Other income not declared elsewhere | 2017-12-31 | $308 |
| Administrative expenses (other) incurred | 2017-12-31 | $364,800 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $146,386 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $456,808 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $4,038,263 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $39,208,432 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $35,170,169 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Investment advisory and management fees | 2017-12-31 | $36,502 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $38,546,546 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $35,664,453 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $1,443,565 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $1,402,015 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $1,402,015 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $11,845 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $1,773,014 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-12-31 | $3,739,868 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $9,229,089 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $9,277,266 |
| Contract administrator fees | 2017-12-31 | $23,633 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $758,078 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $1,046,580 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Disclaimer |
| Accountancy firm name | 2017-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2017-12-31 | 841656069 |
| 2016 : HEALTH PLAN FOR SALARIED EMPLOYEES 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total transfer of assets to this plan | 2016-12-31 | $21,635,948 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $1,503,388 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $907,620 |
| Total income from all sources (including contributions) | 2016-12-31 | $7,940,168 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $7,771,326 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $7,602,040 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $6,692,389 |
| Value of total assets at end of year | 2016-12-31 | $15,037,609 |
| Value of total assets at beginning of year | 2016-12-31 | $14,272,999 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $169,286 |
| Total interest from all sources | 2016-12-31 | $3,101 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $349,878 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $349,878 |
| Administrative expenses professional fees incurred | 2016-12-31 | $29,000 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $826,648 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $34,304 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $199 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $507,297 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $456,808 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $134,123 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $168,842 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $13,534,221 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $13,365,379 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Investment advisory and management fees | 2016-12-31 | $27,317 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $14,482,322 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $13,237,643 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $520,983 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $1,035,157 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $1,035,157 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $3,101 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $402,522 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $894,800 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $5,865,741 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $7,199,518 |
| Contract administrator fees | 2016-12-31 | $112,969 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $1,046,580 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $773,497 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2016-12-31 | 841656069 |
| 2015 : HEALTH PLAN FOR SALARIED EMPLOYEES 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $907,620 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $358,549 |
| Total income from all sources (including contributions) | 2015-12-31 | $5,027,789 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $5,609,488 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $5,439,132 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $4,976,189 |
| Value of total assets at end of year | 2015-12-31 | $14,272,999 |
| Value of total assets at beginning of year | 2015-12-31 | $14,305,627 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $170,356 |
| Total interest from all sources | 2015-12-31 | $1,224 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $311,143 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $311,143 |
| Administrative expenses professional fees incurred | 2015-12-31 | $28,386 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $781,767 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $199 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $31,940 |
| Other income not declared elsewhere | 2015-12-31 | $3,493 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $134,123 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $59,981 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-581,699 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $13,365,379 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $13,947,078 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Investment advisory and management fees | 2015-12-31 | $30,661 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $13,237,643 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $11,452,741 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $1,035,157 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $2,820,946 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $2,820,946 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $1,224 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $396,832 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-264,260 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $4,194,422 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $5,042,300 |
| Contract administrator fees | 2015-12-31 | $111,309 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $773,497 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $298,568 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2015-12-31 | 841656069 |
| 2014 : HEALTH PLAN FOR SALARIED EMPLOYEES 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $358,549 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $1,003,501 |
| Total income from all sources (including contributions) | 2014-12-31 | $3,832,616 |
| Total loss/gain on sale of assets | 2014-12-31 | $-151,148 |
| Total of all expenses incurred | 2014-12-31 | $2,675,030 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $2,478,735 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $2,832,620 |
| Value of total assets at end of year | 2014-12-31 | $14,305,627 |
| Value of total assets at beginning of year | 2014-12-31 | $13,792,993 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $196,295 |
| Total interest from all sources | 2014-12-31 | $29,256 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $269,513 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $269,513 |
| Administrative expenses professional fees incurred | 2014-12-31 | $36,609 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $765,608 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-12-31 | $71 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $31,940 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $42,152 |
| Administrative expenses (other) incurred | 2014-12-31 | $11,901 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $59,981 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $361,897 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $1,157,586 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $13,947,078 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $12,789,492 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $11,452,741 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $10,526,002 |
| Income. Interest from US Government securities | 2014-12-31 | $28,584 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $2,820,946 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $672 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $388,920 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $852,375 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $2,066,941 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $2,089,815 |
| Asset. Corporate debt instrument debt (other) at end of year | 2014-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2014-12-31 | $3,224,839 |
| Contract administrator fees | 2014-12-31 | $147,785 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $298,568 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $641,604 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Aggregate proceeds on sale of assets | 2014-12-31 | $3,219,982 |
| Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $3,371,130 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2014-12-31 | 841656069 |
| 2013 : HEALTH PLAN FOR SALARIED EMPLOYEES 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2013-12-31 | $-117,549 |
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $-117,549 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $1,003,501 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $128,307 |
| Total income from all sources (including contributions) | 2013-12-31 | $4,601,168 |
| Total loss/gain on sale of assets | 2013-12-31 | $709,988 |
| Total of all expenses incurred | 2013-12-31 | $4,037,937 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $3,814,734 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $3,161,091 |
| Value of total assets at end of year | 2013-12-31 | $13,792,993 |
| Value of total assets at beginning of year | 2013-12-31 | $12,354,568 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $223,203 |
| Total interest from all sources | 2013-12-31 | $145,696 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $99,957 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $63,908 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $686,101 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $2,993 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $42,152 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $47,877 |
| Other income not declared elsewhere | 2013-12-31 | $-9,213 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $361,897 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $128,307 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $563,231 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $12,789,492 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $12,226,261 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $10,526,002 |
| Income. Interest from corporate debt instruments | 2013-12-31 | $143,564 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $4,112,092 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $4,112,092 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $2,132 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $360,153 |
| Asset value of US Government securities at beginning of year | 2013-12-31 | $53,239 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $611,198 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $2,471,997 |
| Income. Dividends from common stock | 2013-12-31 | $36,049 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $3,454,581 |
| Asset. Corporate debt instrument debt (other) at end of year | 2013-12-31 | $3,224,839 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2013-12-31 | $3,366,883 |
| Contract administrator fees | 2013-12-31 | $223,203 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2013-12-31 | $4,774,477 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $641,604 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Aggregate proceeds on sale of assets | 2013-12-31 | $9,843,760 |
| Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $9,133,772 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | L J. MOSBY, P.C. |
| Accountancy firm EIN | 2013-12-31 | 841656069 |
| 2012 : HEALTH PLAN FOR SALARIED EMPLOYEES 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-12-31 | $147,712 |
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $147,712 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $128,307 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $131,114 |
| Total income from all sources (including contributions) | 2012-12-31 | $4,766,018 |
| Total loss/gain on sale of assets | 2012-12-31 | $239,862 |
| Total of all expenses incurred | 2012-12-31 | $3,969,610 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $3,423,302 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $4,159,150 |
| Value of total assets at end of year | 2012-12-31 | $12,354,568 |
| Value of total assets at beginning of year | 2012-12-31 | $11,560,967 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $546,308 |
| Total interest from all sources | 2012-12-31 | $146,765 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $72,529 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $14,379 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $597,884 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $95 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $47,877 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $42,801 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $128,307 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $131,114 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $796,408 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $12,226,261 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $11,429,853 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Income. Interest from US Government securities | 2012-12-31 | $140,645 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $4,112,092 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $3,549,557 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $3,549,557 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $6,120 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $3,423,302 |
| Asset value of US Government securities at end of year | 2012-12-31 | $53,239 |
| Asset value of US Government securities at beginning of year | 2012-12-31 | $17,237 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $3,561,171 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $488,333 |
| Income. Dividends from common stock | 2012-12-31 | $72,529 |
| Asset. Corporate debt instrument debt (other) at end of year | 2012-12-31 | $3,366,883 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2012-12-31 | $3,253,027 |
| Contract administrator fees | 2012-12-31 | $531,929 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2012-12-31 | $4,774,477 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2012-12-31 | $4,210,012 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Aggregate proceeds on sale of assets | 2012-12-31 | $4,974,133 |
| Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $4,734,271 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | LS MOSBY, P.C., P.C. |
| Accountancy firm EIN | 2012-12-31 | 841656069 |
| 2011 : HEALTH PLAN FOR SALARIED EMPLOYEES 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-12-31 | $-40,996 |
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $-40,996 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $131,114 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $381,236 |
| Total income from all sources (including contributions) | 2011-12-31 | $3,749,386 |
| Total loss/gain on sale of assets | 2011-12-31 | $150,343 |
| Total of all expenses incurred | 2011-12-31 | $3,186,940 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $2,628,081 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $3,448,334 |
| Value of total assets at end of year | 2011-12-31 | $11,560,967 |
| Value of total assets at beginning of year | 2011-12-31 | $11,248,643 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $558,859 |
| Total interest from all sources | 2011-12-31 | $145,232 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $46,473 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $26,652 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $10,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $761,861 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $1,693 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $42,801 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $42,515 |
| Administrative expenses (other) incurred | 2011-12-31 | $7,607 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $131,114 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $381,236 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $562,446 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $11,429,853 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $10,867,407 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Income. Interest from US Government securities | 2011-12-31 | $140,289 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $3,549,557 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $3,459,354 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $3,459,354 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $4,943 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $2,628,081 |
| Asset value of US Government securities at end of year | 2011-12-31 | $17,237 |
| Asset value of US Government securities at beginning of year | 2011-12-31 | $7,925 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $2,684,780 |
| Employer contributions (assets) at end of year | 2011-12-31 | $488,333 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $244,167 |
| Income. Dividends from common stock | 2011-12-31 | $46,473 |
| Asset. Corporate debt instrument debt (other) at end of year | 2011-12-31 | $3,253,027 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2011-12-31 | $3,189,369 |
| Contract administrator fees | 2011-12-31 | $524,600 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2011-12-31 | $4,210,012 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2011-12-31 | $4,305,313 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Aggregate proceeds on sale of assets | 2011-12-31 | $5,488,716 |
| Aggregate carrying amount (costs) on sale of assets | 2011-12-31 | $5,338,373 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | PUGH & COMPANY, P.C. |
| Accountancy firm EIN | 2011-12-31 | 621142155 |
| 2010 : HEALTH PLAN FOR SALARIED EMPLOYEES 2010 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $309,980 |
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $309,980 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $381,236 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $120,892 |
| Total income from all sources (including contributions) | 2010-12-31 | $4,943,580 |
| Total loss/gain on sale of assets | 2010-12-31 | $24,524 |
| Total of all expenses incurred | 2010-12-31 | $4,016,266 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $3,403,460 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $4,407,101 |
| Value of total assets at end of year | 2010-12-31 | $11,248,643 |
| Value of total assets at beginning of year | 2010-12-31 | $10,060,985 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $612,806 |
| Total interest from all sources | 2010-12-31 | $146,617 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $55,358 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $10,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $1,031,265 |
| Participant contributions at end of year | 2010-12-31 | $7,925 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $4,759 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $42,515 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $41,585 |
| Administrative expenses (other) incurred | 2010-12-31 | $6,386 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $381,236 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $120,892 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $927,314 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $10,867,407 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $9,940,093 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $593,648 |
| Income. Interest from US Government securities | 2010-12-31 | $143,439 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $3,459,354 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $3,052,053 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $3,052,053 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $3,178 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $3,403,460 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $3,371,077 |
| Employer contributions (assets) at end of year | 2010-12-31 | $244,167 |
| Income. Dividends from common stock | 2010-12-31 | $55,358 |
| Asset. Corporate debt instrument debt (other) at end of year | 2010-12-31 | $3,189,369 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2010-12-31 | $3,119,096 |
| Contract administrator fees | 2010-12-31 | $12,772 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2010-12-31 | $4,305,313 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2010-12-31 | $3,848,251 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Aggregate proceeds on sale of assets | 2010-12-31 | $9,435,437 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $9,410,913 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | PUGH & COMPANY, P.C. |
| Accountancy firm EIN | 2010-12-31 | 621142155 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 943788 |
| Policy instance | 9 |
| Insurance contract or identification number | 943788 | | Number of Individuals Covered | 421 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $27,362 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $265,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,362 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $127 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $8,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $127 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,291 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $375,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,291 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,793 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $55,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,793 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927437 |
| Policy instance | 4 |
| Insurance contract or identification number | 927437 | | Number of Individuals Covered | 301 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $72,663 | | Total amount of fees paid to insurance company | USD $6,849 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $354,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,497 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5085 | | Additional information about fees paid to insurance broker | BONUS |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 985 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $29,231 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $145,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,231 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 6 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $286 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $18,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $286 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $12,190 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $713,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,190 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 8 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 13 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $604 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, PERMANENT TOTAL DISABILITY | | 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 $4,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $604 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $133 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $6,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $133 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,201 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $366,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,201 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,560 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $42,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,560 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927437 |
| Policy instance | 4 |
| Insurance contract or identification number | 927437 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $37,076 | | Total amount of fees paid to insurance company | USD $19,039 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $280,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,334 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 12359 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 471 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $29,024 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $145,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,024 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G0066367 |
| Policy instance | 6 |
| Insurance contract or identification number | G0066367 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $5,779 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $98,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,779 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $382 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $18,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $382 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 8 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,634 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $703,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,634 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 9 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $713 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, PERMANENT TOTAL DISABILITY | | 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 $4,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $549 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 943788 |
| Policy instance | 10 |
| Insurance contract or identification number | 943788 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,215 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $140,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,215 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $143 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $11,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $143 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,791 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $399,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,791 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,399 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $39,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,399 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927437 |
| Policy instance | 4 |
| Insurance contract or identification number | 927437 | | Number of Individuals Covered | 348 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $40,831 | | Total amount of fees paid to insurance company | USD $15,345 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $260,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,831 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13610 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 492 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $29,821 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $148,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,821 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G0066367 |
| Policy instance | 6 |
| Insurance contract or identification number | G0066367 | | Number of Individuals Covered | 298 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,516 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $235,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,516 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $313 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $27,396 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $313 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 8 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,798 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $733,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,798 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 9 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 20 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $809 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | 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 $5,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $809 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 8 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,978 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $763,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,978 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $456 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $29,450 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $456 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $191 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $12,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $191 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $6,689 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $426,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,689 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,390 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $39,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,390 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927437 |
| Policy instance | 4 |
| Insurance contract or identification number | 927437 | | Number of Individuals Covered | 351 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $32,732 | | Total amount of fees paid to insurance company | USD $17,095 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $238,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,732 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10911 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDE |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 481 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $28,479 | | Total amount of fees paid to insurance company | USD $359 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $130,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,479 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 359 | | Additional information about fees paid to insurance broker | BONUS |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G0066367 |
| Policy instance | 6 |
| Insurance contract or identification number | G0066367 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $8,206 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $220,293 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,206 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 9 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $850 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, PERMANENT TOTAL DISABILITY | | 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 $5,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $850 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL31629 |
| Policy instance | 4 |
| Insurance contract or identification number | HCL31629 | | Number of Individuals Covered | 331 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $30,313 | | Total amount of fees paid to insurance company | USD $8,589 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $202,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,313 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 8589 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDE |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G0066367 |
| Policy instance | 6 |
| Insurance contract or identification number | G0066367 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $8,163 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $218,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,163 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,491 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $15,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,491 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 471 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $26,960 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $134,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,960 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,137 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $35,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,137 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,452 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $28,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,452 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 8 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $123,596 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $787,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $123,596 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 9 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 20 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $890 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, PERMANENT TOTAL DISABILITY | | 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 $5,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $890 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $67,628 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $437,397 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,628 | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H5253-3902 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $254 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $15,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $254 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H5253-3321 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $6,699 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $409,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,699 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 27343 |
| Policy instance | 3 |
| Insurance contract or identification number | 27343 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,504 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $31,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,504 | | Insurance broker organization code? | 3 | | Insurance broker name | MERITAIN HEALTH, INC. |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL31629 |
| Policy instance | 4 |
| Insurance contract or identification number | HCL31629 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $29,683 | | Total amount of fees paid to insurance company | USD $8,410 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $197,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,683 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 8410 | | Additional information about fees paid to insurance broker | COMMISSION OVERRIDE | | Insurance broker name | CENTERSTONE INS & FIN SERVICES, INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 024315G |
| Policy instance | 5 |
| Insurance contract or identification number | 024315G | | Number of Individuals Covered | 473 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $23,202 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 $116,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,202 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD & JERDEN INC. |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | G0066367 |
| Policy instance | 6 |
| Insurance contract or identification number | G0066367 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2016-03-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $7,963 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 $208,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,963 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3903 |
| Policy instance | 7 |
| Insurance contract or identification number | H5253-3903 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $466 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $27,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $466 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | PAI0009041241-B |
| Policy instance | 9 |
| Insurance contract or identification number | PAI0009041241-B | | Number of Individuals Covered | 23 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,001 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT, PERMANENT TOTAL DISABILITY | | 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 $6,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,001 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD & JERDEN INC. |
|
| UNITED HEALTHCARE OF WISCONSIN, INC. (MEDICARE COMPLETE) (National Association of Insurance Commissioners NAIC id number: 95710 ) |
| Policy contract number | H5253-3904 |
| Policy instance | 8 |
| Insurance contract or identification number | H5253-3904 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $12,996 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $792,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,996 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
|
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | H4456-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H4456-3902 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $286 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $17,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $286 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | H4456-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H4456-3321 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,773 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $379,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,773 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD AND JERDEN INC. |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | H4456-3321 |
| Policy instance | 2 |
| Insurance contract or identification number | H4456-3321 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,842 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $371,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,842 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD & JERDEN |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | H4456-3902 |
| Policy instance | 1 |
| Insurance contract or identification number | H4456-3902 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $318 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $17,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $318 | | Insurance broker organization code? | 3 | | Insurance broker name | PRITCHARD & JERDEN |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | 17021/17022 |
| Policy instance | 1 |
| Insurance contract or identification number | 17021/17022 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $360,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | 17021/17022 |
| Policy instance | 1 |
| Insurance contract or identification number | 17021/17022 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $366,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | |
| Policy instance | 1 |
| Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 1287 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $281,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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