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LIBERTY MUTUAL MEDICAL PLAN 401k Plan overview

Plan NameLIBERTY MUTUAL MEDICAL PLAN
Plan identification number 503

LIBERTY MUTUAL MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

LIBERTY MUTUAL GROUP INC. has sponsored the creation of one or more 401k plans.

Company Name:LIBERTY MUTUAL GROUP INC.
Employer identification number (EIN):043583679
NAIC Classification:524290

Additional information about LIBERTY MUTUAL GROUP INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 4702243

More information about LIBERTY MUTUAL GROUP INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIBERTY MUTUAL MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-01-01
5032022-01-01
5032021-01-01
5032021-01-01
5032020-01-01
5032019-01-01
5032018-01-01
5032017-01-01THOMAS OKSANEN
5032016-01-01THOMAS OKSANEN
5032015-01-01THOMAS OKSANEN
5032014-01-01THOMAS OKSANEN
5032013-01-01THOMAS OKSANEN
5032012-01-01MARY CONNOLLY
5032011-01-01MARY CONNOLLY
5032010-01-01MARY CONNOLLY
5032009-01-01MARY CONNOLLY

Plan Statistics for LIBERTY MUTUAL MEDICAL PLAN

401k plan membership statisitcs for LIBERTY MUTUAL MEDICAL PLAN

Measure Date Value
2023: LIBERTY MUTUAL MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-0132,847
Total number of active participants reported on line 7a of the Form 55002023-01-0129,118
Number of retired or separated participants receiving benefits2023-01-011,491
Number of other retired or separated participants entitled to future benefits2023-01-011,565
Total of all active and inactive participants2023-01-0132,174
2022: LIBERTY MUTUAL MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0135,206
Total number of active participants reported on line 7a of the Form 55002022-01-0128,449
Number of retired or separated participants receiving benefits2022-01-012,467
Number of other retired or separated participants entitled to future benefits2022-01-014,751
Total of all active and inactive participants2022-01-0135,667
2021: LIBERTY MUTUAL MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0130,197
Total number of active participants reported on line 7a of the Form 55002021-01-0127,181
Number of retired or separated participants receiving benefits2021-01-012,602
Number of other retired or separated participants entitled to future benefits2021-01-015,478
Total of all active and inactive participants2021-01-0135,261
2020: LIBERTY MUTUAL MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0130,583
Total number of active participants reported on line 7a of the Form 55002020-01-0127,988
Number of retired or separated participants receiving benefits2020-01-011,357
Number of other retired or separated participants entitled to future benefits2020-01-011,867
Total of all active and inactive participants2020-01-0131,212
2019: LIBERTY MUTUAL MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0131,012
Total number of active participants reported on line 7a of the Form 55002019-01-0128,893
Number of retired or separated participants receiving benefits2019-01-011,380
Number of other retired or separated participants entitled to future benefits2019-01-01481
Total of all active and inactive participants2019-01-0130,754
2018: LIBERTY MUTUAL MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0134,039
Total number of active participants reported on line 7a of the Form 55002018-01-0129,176
Number of retired or separated participants receiving benefits2018-01-011,574
Number of other retired or separated participants entitled to future benefits2018-01-01570
Total of all active and inactive participants2018-01-0131,320
2017: LIBERTY MUTUAL MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0140,715
Total number of active participants reported on line 7a of the Form 55002017-01-0132,490
Number of retired or separated participants receiving benefits2017-01-017,662
Number of other retired or separated participants entitled to future benefits2017-01-01165
Total of all active and inactive participants2017-01-0140,317
2016: LIBERTY MUTUAL MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0134,155
Total number of active participants reported on line 7a of the Form 55002016-01-0133,421
Number of retired or separated participants receiving benefits2016-01-017,548
Number of other retired or separated participants entitled to future benefits2016-01-0172
Total of all active and inactive participants2016-01-0141,041
2015: LIBERTY MUTUAL MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0133,356
Total number of active participants reported on line 7a of the Form 55002015-01-0134,205
Number of retired or separated participants receiving benefits2015-01-017,694
Number of other retired or separated participants entitled to future benefits2015-01-0119
Total of all active and inactive participants2015-01-0141,918
Total participants2015-01-0141,918
2014: LIBERTY MUTUAL MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0141,930
Total number of active participants reported on line 7a of the Form 55002014-01-0133,276
Number of retired or separated participants receiving benefits2014-01-017,931
Number of other retired or separated participants entitled to future benefits2014-01-0117
Total of all active and inactive participants2014-01-0141,224
Total participants2014-01-0141,224
2013: LIBERTY MUTUAL MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0141,808
Total number of active participants reported on line 7a of the Form 55002013-01-0133,808
Number of retired or separated participants receiving benefits2013-01-018,237
Number of other retired or separated participants entitled to future benefits2013-01-0117
Total of all active and inactive participants2013-01-0142,062
Total participants2013-01-0142,062
2012: LIBERTY MUTUAL MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0142,148
Total number of active participants reported on line 7a of the Form 55002012-01-0133,995
Number of retired or separated participants receiving benefits2012-01-019,228
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0143,223
Total participants2012-01-0143,223
2011: LIBERTY MUTUAL MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0141,894
Total number of active participants reported on line 7a of the Form 55002011-01-0132,869
Number of retired or separated participants receiving benefits2011-01-019,391
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0142,260
2010: LIBERTY MUTUAL MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0142,087
Total number of active participants reported on line 7a of the Form 55002010-01-0132,538
Number of retired or separated participants receiving benefits2010-01-019,612
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0142,150
2009: LIBERTY MUTUAL MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0144,025
Total number of active participants reported on line 7a of the Form 55002009-01-0132,137
Number of retired or separated participants receiving benefits2009-01-0110,131
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0142,268
Total participants2009-01-0142,268

Form 5500 Responses for LIBERTY MUTUAL MEDICAL PLAN

2023: LIBERTY MUTUAL MEDICAL PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: LIBERTY MUTUAL MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: LIBERTY MUTUAL MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: LIBERTY MUTUAL MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: LIBERTY MUTUAL MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: LIBERTY MUTUAL MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: LIBERTY MUTUAL MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: LIBERTY MUTUAL MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: LIBERTY MUTUAL MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: LIBERTY MUTUAL MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: LIBERTY MUTUAL MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: LIBERTY MUTUAL MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: LIBERTY MUTUAL MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: LIBERTY MUTUAL MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: LIBERTY MUTUAL MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered92
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $830,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered92
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $879,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered92
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $843,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered92
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $792,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered97
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $742,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered88
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $778,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number905509
Policy instance 1
Insurance contract or identification number905509
Number of Individuals Covered96
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $780,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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