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TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 401k Plan overview

Plan NameTOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN
Plan identification number 501

TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TOWN FAIR TIRE CENTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name:TOWN FAIR TIRE CENTERS, INC.
Employer identification number (EIN):060767684
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01KATHRYN TUTINO
5012017-01-01KATHRYN TUTINO
5012016-01-01KATHRYN TUTINO
5012015-01-01KATHRYN TUTINO
5012014-01-01KATHRYN TUTINO
5012013-01-01KATHRYN TUTINO
5012012-01-01KATHRYN TUTINO
5012011-01-01KATHRYN TUTINO
5012010-01-01KATHRYN TUTINO
5012009-01-01KATHY TUTINO

Plan Statistics for TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN

401k plan membership statisitcs for TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN

Measure Date Value
2022: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,110
Total number of active participants reported on line 7a of the Form 55002022-01-011,094
Total of all active and inactive participants2022-01-011,094
2021: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,148
Total number of active participants reported on line 7a of the Form 55002021-01-011,110
Total of all active and inactive participants2021-01-011,110
2020: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,135
Total number of active participants reported on line 7a of the Form 55002020-01-011,148
Total of all active and inactive participants2020-01-011,148
2019: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,115
Total number of active participants reported on line 7a of the Form 55002019-01-011,135
Total of all active and inactive participants2019-01-011,135
2018: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,053
Total number of active participants reported on line 7a of the Form 55002018-01-011,115
Total of all active and inactive participants2018-01-011,115
2017: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,022
Total number of active participants reported on line 7a of the Form 55002017-01-011,053
Total of all active and inactive participants2017-01-011,053
2016: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,046
Total number of active participants reported on line 7a of the Form 55002016-01-011,022
Total of all active and inactive participants2016-01-011,022
2015: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01840
Total number of active participants reported on line 7a of the Form 55002015-01-011,046
Total of all active and inactive participants2015-01-011,046
2014: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01630
Total number of active participants reported on line 7a of the Form 55002014-01-01835
Number of retired or separated participants receiving benefits2014-01-015
Total of all active and inactive participants2014-01-01840
2013: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01628
Total number of active participants reported on line 7a of the Form 55002013-01-01544
Number of retired or separated participants receiving benefits2013-01-015
Total of all active and inactive participants2013-01-01549
2012: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01645
Total number of active participants reported on line 7a of the Form 55002012-01-01607
Total of all active and inactive participants2012-01-01607
2011: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01638
Total number of active participants reported on line 7a of the Form 55002011-01-01613
Number of retired or separated participants receiving benefits2011-01-010
Total of all active and inactive participants2011-01-01613
2010: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01594
Total number of active participants reported on line 7a of the Form 55002010-01-01617
Number of retired or separated participants receiving benefits2010-01-012
Total of all active and inactive participants2010-01-01619
2009: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01552
Total number of active participants reported on line 7a of the Form 55002009-01-01591
Number of retired or separated participants receiving benefits2009-01-013
Total of all active and inactive participants2009-01-01594

Financial Data on TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN

Measure Date Value
2013 : TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$1,601,428
Total income from all sources (including contributions)2013-12-31$4,418,027
Total of all expenses incurred2013-12-31$4,418,027
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,900,319
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$4,417,486
Value of total assets at end of year2013-12-31$0
Value of total assets at beginning of year2013-12-31$1,601,428
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$517,708
Total interest from all sources2013-12-31$541
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$2,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$2,549,651
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$437,551
Liabilities. Value of operating payables at end of year2013-12-31$0
Liabilities. Value of operating payables at beginning of year2013-12-31$81,301
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$426,586
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$426,586
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$541
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$414,546
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$1,430,284
Employer contributions (assets) at end of year2013-12-31$0
Employer contributions (assets) at beginning of year2013-12-31$1,174,842
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$3,485,773
Contract administrator fees2013-12-31$517,708
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$1,520,127
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31FRIEDBERG, SMITH & COMPANY PC
Accountancy firm EIN2013-12-31061331879
2012 : TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,601,428
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,293,968
Total income from all sources (including contributions)2012-12-31$5,881,343
Total of all expenses incurred2012-12-31$5,881,343
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$5,345,817
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$5,880,527
Value of total assets at end of year2012-12-31$1,601,428
Value of total assets at beginning of year2012-12-31$1,293,968
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$535,526
Total interest from all sources2012-12-31$816
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$4,000
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$2,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$2,489,180
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$64,538
Administrative expenses (other) incurred2012-12-31$6,422
Liabilities. Value of operating payables at end of year2012-12-31$81,301
Liabilities. Value of operating payables at beginning of year2012-12-31$80,984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$0
Value of net assets at end of year (total assets less liabilities)2012-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$426,586
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$605,228
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$605,228
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$816
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$474,299
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$3,326,809
Employer contributions (assets) at end of year2012-12-31$1,174,842
Employer contributions (assets) at beginning of year2012-12-31$688,740
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$4,871,518
Contract administrator fees2012-12-31$525,104
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$1,520,127
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$1,212,984
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31FRIEDBERG, SMITH & COMPANY PC
Accountancy firm EIN2012-12-31061331879
2011 : TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,293,968
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,332,768
Total income from all sources (including contributions)2011-12-31$4,921,883
Total of all expenses incurred2011-12-31$4,921,883
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$4,401,086
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$4,921,221
Value of total assets at end of year2011-12-31$1,293,968
Value of total assets at beginning of year2011-12-31$1,332,768
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$520,797
Total interest from all sources2011-12-31$662
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$2,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$2,480,175
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$400,389
Administrative expenses (other) incurred2011-12-31$1,817
Liabilities. Value of operating payables at end of year2011-12-31$80,984
Liabilities. Value of operating payables at beginning of year2011-12-31$79,166
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$0
Value of net assets at end of year (total assets less liabilities)2011-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$605,228
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$364,019
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$364,019
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$662
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$499,345
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$2,040,657
Employer contributions (assets) at end of year2011-12-31$688,740
Employer contributions (assets) at beginning of year2011-12-31$968,749
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$3,901,741
Contract administrator fees2011-12-31$518,980
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$1,212,984
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$1,253,602
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31FRIEDBERG, SMITH & COMPANY PC
Accountancy firm EIN2011-12-31061331879
2010 : TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$1,332,768
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$1,227,205
Total income from all sources (including contributions)2010-12-31$4,990,411
Total of all expenses incurred2010-12-31$4,990,411
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$4,497,396
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$4,989,913
Value of total assets at end of year2010-12-31$1,332,768
Value of total assets at beginning of year2010-12-31$1,227,205
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$493,015
Total interest from all sources2010-12-31$498
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$2,000
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$2,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$2,241,503
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$276,299
Administrative expenses (other) incurred2010-12-31$833
Liabilities. Value of operating payables at end of year2010-12-31$79,166
Liabilities. Value of operating payables at beginning of year2010-12-31$69,213
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$0
Value of net assets at end of year (total assets less liabilities)2010-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$364,019
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$378,243
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$378,243
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$498
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$442,419
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,472,111
Employer contributions (assets) at end of year2010-12-31$968,749
Employer contributions (assets) at beginning of year2010-12-31$848,962
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$4,054,977
Contract administrator fees2010-12-31$490,182
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$1,253,602
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$1,157,992
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31FRIEDBERG, SMITH & COMPANY PC
Accountancy firm EIN2010-12-31061331879

Form 5500 Responses for TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN

2022: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: TOWN FAIR TIRE CENTERS, INC. EMPLOYEES' BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1094
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,881
Total amount of fees paid to insurance companyUSD $1,132
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,881
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees1132
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered526
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,715
Total amount of fees paid to insurance companyUSD $1,574
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,715
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees1574
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1110
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,861
Total amount of fees paid to insurance companyUSD $457
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,861
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees457
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered528
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,630
Total amount of fees paid to insurance companyUSD $639
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,630
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees639
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered527
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,639
Total amount of fees paid to insurance companyUSD $625
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,639
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Amount paid for insurance broker fees625
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1148
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,880
Total amount of fees paid to insurance companyUSD $453
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,880
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Amount paid for insurance broker fees453
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1135
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,864
Total amount of fees paid to insurance companyUSD $388
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,864
Amount paid for insurance broker fees388
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered525
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,625
Total amount of fees paid to insurance companyUSD $501
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,625
Amount paid for insurance broker fees501
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1115
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,604
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,604
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered524
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,503
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,503
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 155087
Policy instance 2
Insurance contract or identification numberGL 155087
Number of Individuals Covered1053
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,266
Total amount of fees paid to insurance companyUSD $1,357
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,266
Amount paid for insurance broker fees1357
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameWILLIS OF CONNECTICUT LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 126902
Policy instance 1
Insurance contract or identification numberLTD 126902
Number of Individuals Covered529
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,045
Total amount of fees paid to insurance companyUSD $2,077
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,045
Amount paid for insurance broker fees2077
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameWILLIS OF CONNECTICUT LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150211
Policy instance 1
Insurance contract or identification number000010150211
Number of Individuals Covered521
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,753
Total amount of fees paid to insurance companyUSD $339
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,753
Insurance broker organization code?3
Amount paid for insurance broker fees339
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150210
Policy instance 2
Insurance contract or identification number000010150210
Number of Individuals Covered1046
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,599
Total amount of fees paid to insurance companyUSD $226
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,599
Insurance broker organization code?3
Amount paid for insurance broker fees226
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150211
Policy instance 1
Insurance contract or identification number000010150211
Number of Individuals Covered477
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,261
Total amount of fees paid to insurance companyUSD $1,100
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,261
Insurance broker organization code?3
Amount paid for insurance broker fees1100
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150210
Policy instance 2
Insurance contract or identification number000010150210
Number of Individuals Covered835
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,514
Total amount of fees paid to insurance companyUSD $751
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,514
Insurance broker organization code?3
Amount paid for insurance broker fees751
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number085386
Policy instance 2
Insurance contract or identification number085386
Number of Individuals Covered549
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001015210
Policy instance 3
Insurance contract or identification number00001015210
Number of Individuals Covered549
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,522
Total amount of fees paid to insurance companyUSD $229
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,522
Insurance broker organization code?3
Amount paid for insurance broker fees229
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150211
Policy instance 1
Insurance contract or identification number000010150211
Number of Individuals Covered451
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,233
Total amount of fees paid to insurance companyUSD $315
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,233
Insurance broker organization code?3
Amount paid for insurance broker fees315
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010150211
Policy instance 1
Insurance contract or identification number000010150211
Number of Individuals Covered451
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,276
Total amount of fees paid to insurance companyUSD $595
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,276
Insurance broker organization code?3
Amount paid for insurance broker fees595
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001015210
Policy instance 3
Insurance contract or identification number00001015210
Number of Individuals Covered607
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,597
Total amount of fees paid to insurance companyUSD $458
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,597
Insurance broker organization code?3
Amount paid for insurance broker fees458
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWILLIS OF ARIZONA INC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number085386
Policy instance 2
Insurance contract or identification number085386
Number of Individuals Covered607
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000649D
Policy instance 1
Insurance contract or identification numberG000649D
Number of Individuals Covered613
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,271
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $100,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number085386
Policy instance 2
Insurance contract or identification number085386
Number of Individuals Covered613
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number085386
Policy instance 2
Insurance contract or identification number085386
Number of Individuals Covered619
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $33,216
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000649D
Policy instance 1
Insurance contract or identification numberG000649D
Number of Individuals Covered869
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,108
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $95,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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