MARTIN OIL COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MARTIN OIL COMPANY HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2022: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-02-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 174 |
Number of retired or separated participants receiving benefits | 2022-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
Total of all active and inactive participants | 2022-02-01 | 174 |
2021: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-02-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 172 |
Number of retired or separated participants receiving benefits | 2021-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
Total of all active and inactive participants | 2021-02-01 | 172 |
2020: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-02-01 | 167 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 166 |
Number of retired or separated participants receiving benefits | 2020-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
Total of all active and inactive participants | 2020-02-01 | 166 |
2019: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-02-01 | 164 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 167 |
Number of retired or separated participants receiving benefits | 2019-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
Total of all active and inactive participants | 2019-02-01 | 167 |
2018: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-02-01 | 162 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 164 |
Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
Total of all active and inactive participants | 2018-02-01 | 164 |
2022: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2022 form 5500 responses |
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2022-02-01 | Type of plan entity | Single employer plan |
2022-02-01 | Submission has been amended | No |
2022-02-01 | This submission is the final filing | No |
2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-02-01 | Plan is a collectively bargained plan | No |
2022-02-01 | Plan funding arrangement – Insurance | Yes |
2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-02-01 | Plan benefit arrangement – Insurance | Yes |
2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2021 form 5500 responses |
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2021-02-01 | Type of plan entity | Single employer plan |
2021-02-01 | Submission has been amended | No |
2021-02-01 | This submission is the final filing | No |
2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-02-01 | Plan is a collectively bargained plan | No |
2021-02-01 | Plan funding arrangement – Insurance | Yes |
2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-02-01 | Plan benefit arrangement – Insurance | Yes |
2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2020 form 5500 responses |
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2020-02-01 | Type of plan entity | Single employer plan |
2020-02-01 | Submission has been amended | No |
2020-02-01 | This submission is the final filing | No |
2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-02-01 | Plan is a collectively bargained plan | No |
2020-02-01 | Plan funding arrangement – Insurance | Yes |
2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-02-01 | Plan benefit arrangement – Insurance | Yes |
2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2019 form 5500 responses |
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2019-02-01 | Type of plan entity | Single employer plan |
2019-02-01 | Submission has been amended | No |
2019-02-01 | This submission is the final filing | No |
2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-02-01 | Plan is a collectively bargained plan | No |
2019-02-01 | Plan funding arrangement – Insurance | Yes |
2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-02-01 | Plan benefit arrangement – Insurance | Yes |
2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: MARTIN OIL COMPANY HEALTH AND WELFARE PLAN 2018 form 5500 responses |
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2018-02-01 | Type of plan entity | Single employer plan |
2018-02-01 | First time form 5500 has been submitted | Yes |
2018-02-01 | Submission has been amended | No |
2018-02-01 | This submission is the final filing | No |
2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-02-01 | Plan is a collectively bargained plan | No |
2018-02-01 | Plan funding arrangement – Insurance | Yes |
2018-02-01 | Plan benefit arrangement – Insurance | Yes |
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851800 |
Policy instance | 1 |
Insurance contract or identification number | 15851800 | Number of Individuals Covered | 157 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $54,501 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,362,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,501 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 920535 & SUBS |
Policy instance | 4 |
Insurance contract or identification number | 920535 & SUBS | Number of Individuals Covered | 57 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $3,559 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $33,434 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,559 | Insurance broker organization code? | 3 |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00614120 |
Policy instance | 3 |
Insurance contract or identification number | G 00614120 | Number of Individuals Covered | 174 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $17,808 | Total amount of fees paid to insurance company | USD $4,777 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $169,345 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,808 | Amount paid for insurance broker fees | 4777 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2802 |
Policy instance | 2 |
Insurance contract or identification number | 2802 | Number of Individuals Covered | 108 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $297 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $297 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851800 |
Policy instance | 1 |
Insurance contract or identification number | 15851800 | Number of Individuals Covered | 188 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $58,902 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,484,277 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $58,902 | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2802 |
Policy instance | 2 |
Insurance contract or identification number | 2802 | Number of Individuals Covered | 121 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $529 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $529 | Insurance broker organization code? | 3 |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00614120 |
Policy instance | 3 |
Insurance contract or identification number | G 00614120 | Number of Individuals Covered | 172 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $16,867 | Total amount of fees paid to insurance company | USD $4,321 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $159,279 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,867 | Amount paid for insurance broker fees | 4321 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 920535 & SUBS |
Policy instance | 4 |
Insurance contract or identification number | 920535 & SUBS | Number of Individuals Covered | 58 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $4,407 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $41,189 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,407 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 920535 & SUBS |
Policy instance | 4 |
Insurance contract or identification number | 920535 & SUBS | Number of Individuals Covered | 72 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $4,176 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $37,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,176 | Insurance broker organization code? | 3 |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00614120 |
Policy instance | 3 |
Insurance contract or identification number | G 00614120 | Number of Individuals Covered | 166 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $15,480 | Total amount of fees paid to insurance company | USD $4,246 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $143,838 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,480 | Amount paid for insurance broker fees | 4246 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2802 |
Policy instance | 2 |
Insurance contract or identification number | 2802 | Number of Individuals Covered | 120 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $341 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $341 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851800 |
Policy instance | 1 |
Insurance contract or identification number | 15851800 | Number of Individuals Covered | 196 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $48,466 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,324,494 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,466 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851302 |
Policy instance | 1 |
Insurance contract or identification number | 15851302 | Number of Individuals Covered | 193 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $50,409 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,152,667 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $50,409 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851902 |
Policy instance | 2 |
Insurance contract or identification number | 15851902 | Number of Individuals Covered | 0 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2802 |
Policy instance | 3 |
Insurance contract or identification number | 2802 | Number of Individuals Covered | 125 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $541 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $541 | Insurance broker organization code? | 3 |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00614120 |
Policy instance | 4 |
Insurance contract or identification number | G 00614120 | Number of Individuals Covered | 167 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $14,865 | Total amount of fees paid to insurance company | USD $3,811 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $139,734 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,865 | Amount paid for insurance broker fees | 3811 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 920535 & SUBS |
Policy instance | 5 |
Insurance contract or identification number | 920535 & SUBS | Number of Individuals Covered | 60 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $3,356 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $33,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,356 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 920535 & SUBS |
Policy instance | 5 |
Insurance contract or identification number | 920535 & SUBS | Number of Individuals Covered | 54 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $2,958 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $28,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,958 | Insurance broker organization code? | 3 |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00614120 |
Policy instance | 4 |
Insurance contract or identification number | G 00614120 | Number of Individuals Covered | 164 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $14,196 | Total amount of fees paid to insurance company | USD $4,132 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $133,797 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,196 | Amount paid for insurance broker fees | 4132 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 2802 |
Policy instance | 3 |
Insurance contract or identification number | 2802 | Number of Individuals Covered | 127 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $384 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $384 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851902 |
Policy instance | 2 |
Insurance contract or identification number | 15851902 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $19 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $-997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 15851302 |
Policy instance | 1 |
Insurance contract or identification number | 15851302 | Number of Individuals Covered | 125 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $49,968 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,267,988 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $49,968 | Insurance broker organization code? | 3 |
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