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NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 401k Plan overview

Plan NameNEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN
Plan identification number 502

NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

NEW WINCUP HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:NEW WINCUP HOLDINGS, INC.
Employer identification number (EIN):205897540
NAIC Classification:326100

Additional information about NEW WINCUP HOLDINGS, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2006-11-27
Company Identification Number: 0800738044
Legal Registered Office Address: 4640 LEWIS RD ATTN: GINGER CLARK

STONE MTN
United States of America (USA)
30083

More information about NEW WINCUP HOLDINGS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-04-01PATRICIA HAUBER2023-10-19
5022021-04-01PATRICIA HAUBER2022-08-29
5022020-04-01KELLEY A. ROWELL2021-10-01
5022019-04-01KELLEY ROWELL2020-12-17
5022018-04-01
5022017-04-01KELLEY A. ROWELL
5022016-04-01KELLEY ROWELL KELLEY ROWELL2017-09-20
5022015-04-01KELLEY ROWELL KELLEY ROWELL2016-10-31
5022014-04-01TANISHA SIMS TANISHA SIMS2015-10-29
5022013-04-01BEV JOHNSON BEV JOHNSON2014-10-30
5022012-04-01BEV JOHNSON BEV JOHNSON2013-11-01
5022011-04-01KIMBERLY KNOTTS KIMBERLY KNOTTS2012-10-30
5022010-04-01DANIELLE LEHMAN DANIELLE LEHMAN2011-10-27
5022009-04-01ERIC ARMSTRONG ERIC ARMSTRONG2010-11-04

Plan Statistics for NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN

401k plan membership statisitcs for NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN

Measure Date Value
2022: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01815
Total number of active participants reported on line 7a of the Form 55002022-04-01821
Number of retired or separated participants receiving benefits2022-04-011
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01822
Number of employers contributing to the scheme2022-04-010
2021: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01549
Total number of active participants reported on line 7a of the Form 55002021-04-01750
Number of retired or separated participants receiving benefits2021-04-014
Number of other retired or separated participants entitled to future benefits2021-04-014
Total of all active and inactive participants2021-04-01758
Number of employers contributing to the scheme2021-04-010
2020: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01853
Total number of active participants reported on line 7a of the Form 55002020-04-01806
Number of retired or separated participants receiving benefits2020-04-014
Number of other retired or separated participants entitled to future benefits2020-04-0144
Total of all active and inactive participants2020-04-01854
Number of employers contributing to the scheme2020-04-010
2019: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01896
Total number of active participants reported on line 7a of the Form 55002019-04-01853
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01853
Number of employers contributing to the scheme2019-04-010
2018: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01987
Total number of active participants reported on line 7a of the Form 55002018-04-01895
Number of retired or separated participants receiving benefits2018-04-011
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01896
2017: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01950
Total number of active participants reported on line 7a of the Form 55002017-04-01908
Number of retired or separated participants receiving benefits2017-04-011
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01909
2016: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01615
Total number of active participants reported on line 7a of the Form 55002016-04-01950
Number of retired or separated participants receiving benefits2016-04-012
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01952
2015: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01604
Total number of active participants reported on line 7a of the Form 55002015-04-01615
Number of retired or separated participants receiving benefits2015-04-013
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01618
2014: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01589
Total number of active participants reported on line 7a of the Form 55002014-04-01604
Number of retired or separated participants receiving benefits2014-04-01260
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01864
2013: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01601
Total number of active participants reported on line 7a of the Form 55002013-04-01589
Number of retired or separated participants receiving benefits2013-04-014
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01593
2012: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01584
Total number of active participants reported on line 7a of the Form 55002012-04-01601
Number of retired or separated participants receiving benefits2012-04-015
Total of all active and inactive participants2012-04-01606
2011: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-011,035
Total number of active participants reported on line 7a of the Form 55002011-04-01584
Number of retired or separated participants receiving benefits2011-04-0115
Total of all active and inactive participants2011-04-01599
2010: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-011,019
Total number of active participants reported on line 7a of the Form 55002010-04-011,003
Number of retired or separated participants receiving benefits2010-04-0111
Number of other retired or separated participants entitled to future benefits2010-04-0121
Total of all active and inactive participants2010-04-011,035
2009: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-011,187
Total number of active participants reported on line 7a of the Form 55002009-04-01968
Number of retired or separated participants receiving benefits2009-04-0127
Number of other retired or separated participants entitled to future benefits2009-04-0124
Total of all active and inactive participants2009-04-011,019

Form 5500 Responses for NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN

2022: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2010: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – General assets of the sponsorYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: NEW WINCUP HOLDINGS, INC. HEATH AND WELFARE PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number240719
Policy instance 2
Insurance contract or identification number240719
Number of Individuals Covered856
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $14,467
Total amount of fees paid to insurance companyUSD $2,747
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,HOSPITAL,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $288,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,467
Amount paid for insurance broker fees348
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 1
Insurance contract or identification number12309743
Number of Individuals Covered397
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number511132
Policy instance 2
Insurance contract or identification number511132
Number of Individuals Covered805
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $29,052
Total amount of fees paid to insurance companyUSD $6,944
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $375,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,052
Amount paid for insurance broker fees6944
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 1
Insurance contract or identification number12309743
Number of Individuals Covered386
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number511132
Policy instance 2
Insurance contract or identification number511132
Number of Individuals Covered786
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $33,008
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $430,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,129
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 1
Insurance contract or identification number12309743
Number of Individuals Covered426
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number363560825
Policy instance 1
Insurance contract or identification number363560825
Number of Individuals Covered420
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number511132
Policy instance 2
Insurance contract or identification number511132
Number of Individuals Covered853
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $36,307
Total amount of fees paid to insurance companyUSD $3,315
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $463,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,307
Amount paid for insurance broker fees3315
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 3
Insurance contract or identification number12309743
Number of Individuals Covered474
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $50,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00511132
Policy instance 2
Insurance contract or identification number00511132
Number of Individuals Covered895
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $23,343
Total amount of fees paid to insurance companyUSD $343
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
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 $485,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,792
Amount paid for insurance broker fees343
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 1
Insurance contract or identification number3173424
Number of Individuals Covered1047
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
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 BenefitNo
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 $491,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 1
Insurance contract or identification number3173424
Number of Individuals Covered1150
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 BenefitNo
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 $495,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 3
Insurance contract or identification number12309743
Number of Individuals Covered495
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $47,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00511132
Policy instance 2
Insurance contract or identification number00511132
Number of Individuals Covered987
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $9,888
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 CarrierUSD $365,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees9888
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameREGIONS INSURANCE INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 1
Insurance contract or identification number3173424
Number of Individuals Covered1060
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Welfare Benefit Premiums Paid to CarrierUSD $546,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00511132
Policy instance 2
Insurance contract or identification number00511132
Number of Individuals Covered874
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of fees paid to insurance companyUSD $6,550
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $195,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6550
Insurance broker name
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 5
Insurance contract or identification number12309743
Number of Individuals Covered427
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0336529
Policy instance 9
Insurance contract or identification numberR0336529
Number of Individuals Covered63
Insurance policy start date2014-04-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $1,637
Other welfare benefits providedGCIEE
Welfare Benefit Premiums Paid to CarrierUSD $15,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,169
Insurance broker organization code?4
Insurance broker nameEQUITY RISK PARTNERS INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400003002
Policy instance 8
Insurance contract or identification number000400003002
Number of Individuals Covered56
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0009045640
Policy instance 7
Insurance contract or identification number0009045640
Number of Individuals Covered194
Insurance policy start date2014-04-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $1,323
Other welfare benefits providedVWB (ACCCIDENT)
Welfare Benefit Premiums Paid to CarrierUSD $26,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $922
Insurance broker organization code?4
Insurance broker nameEQUITY RISK PARTNERS, INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 6
Insurance contract or identification number3173424
Number of Individuals Covered1084
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Welfare Benefit Premiums Paid to CarrierUSD $462,479
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 number000400001000
Policy instance 4
Insurance contract or identification number000400001000
Number of Individuals Covered216
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,948
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 number000010091114
Policy instance 3
Insurance contract or identification number000010091114
Number of Individuals Covered126
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,803
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 number000010091113
Policy instance 2
Insurance contract or identification number000010091113
Number of Individuals Covered900
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $66,034
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 number000010093507
Policy instance 1
Insurance contract or identification number000010093507
Number of Individuals Covered807
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 6
Insurance contract or identification number3173424
Number of Individuals Covered1077
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Welfare Benefit Premiums Paid to CarrierUSD $482,621
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 number000010091114
Policy instance 3
Insurance contract or identification number000010091114
Number of Individuals Covered130
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,573
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 number000400001000
Policy instance 4
Insurance contract or identification number000400001000
Number of Individuals Covered221
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,710
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 number000010091113
Policy instance 2
Insurance contract or identification number000010091113
Number of Individuals Covered931
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $70,700
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 number000010093507
Policy instance 1
Insurance contract or identification number000010093507
Number of Individuals Covered691
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 5
Insurance contract or identification number12309743
Number of Individuals Covered423
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0009045640
Policy instance 7
Insurance contract or identification number0009045640
Number of Individuals Covered194
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $2,593
Other welfare benefits providedVWB (ACCCIDENT)
Welfare Benefit Premiums Paid to CarrierUSD $43,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,791
Insurance broker organization code?4
Insurance broker nameEQUITY RISK PARTNERS, INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3173424
Policy instance 8
Insurance contract or identification number3173424
Number of Individuals Covered1055
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Welfare Benefit Premiums Paid to CarrierUSD $431,363
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 number000010093507
Policy instance 2
Insurance contract or identification number000010093507
Number of Individuals Covered709
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Long Term Disability 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 number000400003002
Policy instance 7
Insurance contract or identification number000400003002
Number of Individuals Covered72
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of fees paid to insurance companyUSD $2,072
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2072
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameEQUITY RISK PARTNERS, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 6
Insurance contract or identification number12309743
Number of Individuals Covered418
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Vision 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 number000400001000
Policy instance 5
Insurance contract or identification number000400001000
Number of Individuals Covered235
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of fees paid to insurance companyUSD $5,524
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5524
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameEQUITY RISK PARTNERS, INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010091114
Policy instance 4
Insurance contract or identification number000010091114
Number of Individuals Covered119
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of fees paid to insurance companyUSD $1,839
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1839
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameEQUITY RISK PARTNERS, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010091113
Policy instance 3
Insurance contract or identification number000010091113
Number of Individuals Covered82
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of fees paid to insurance companyUSD $3,162
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3162
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameEQUITY RISK PARTNERS, INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8005
Policy instance 1
Insurance contract or identification number8005
Number of Individuals Covered3
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Welfare Benefit Premiums Paid to CarrierUSD $41,530
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 number000010093507
Policy instance 2
Insurance contract or identification number000010093507
Number of Individuals Covered656
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 7
Insurance contract or identification number12309743
Number of Individuals Covered423
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8005
Policy instance 1
Insurance contract or identification number8005
Number of Individuals Covered15
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3173424
Policy instance 6
Insurance contract or identification number3173424
Number of Individuals Covered584
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Welfare Benefit Premiums Paid to CarrierUSD $419,382
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 number0004000010000
Policy instance 5
Insurance contract or identification number0004000010000
Number of Individuals Covered243
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,456
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 number000010091114
Policy instance 4
Insurance contract or identification number000010091114
Number of Individuals Covered122
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,976
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 number000010091113
Policy instance 3
Insurance contract or identification number000010091113
Number of Individuals Covered87
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $40,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number8005
Policy instance 2
Insurance contract or identification number8005
Number of Individuals Covered198
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $749,035
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 number000010091113
Policy instance 3
Insurance contract or identification number000010091113
Number of Individuals Covered941
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,622
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, V. CHILD LIFE, V. SPOUSE LIFE
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 $306,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12309743
Policy instance 4
Insurance contract or identification number12309743
Number of Individuals Covered466
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3173424
Policy instance 1
Insurance contract or identification number3173424
Number of Individuals Covered1091
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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 $353,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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