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INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 401k Plan overview

Plan NameINT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN
Plan identification number 502

INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance

401k Sponsoring company profile

IH CREDIT UNION, INC. has sponsored the creation of one or more 401k plans.

Company Name:IH CREDIT UNION, INC.
Employer identification number (EIN):310502711
NAIC Classification:522130
NAIC Description:Credit Unions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-02-01
5022020-02-01
5022019-02-01
5022018-02-01
5022017-02-01ROBB WHITE
5022016-02-01ROBB WHITE ROBB WHITE2017-08-03
5022015-02-01ROBB WHITE2016-08-04 ROBB WHITE2016-08-04
5022014-02-01ROBB WHITE2015-11-11 ROBB WHITE2015-11-12
5022013-02-01ROBB WHITE2014-11-14 ROBB WHITE2014-11-14
5022012-02-01JAMES KITCHEN2013-11-14 JAMES KITCHEN2013-11-14
5022011-02-01JAMES KITCHEN2012-11-14 JAMES KITCHEN2012-11-15
5022009-02-01JAMES KITCHEN2010-11-15 JAMES KITCHEN2010-11-15

Plan Statistics for INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN

401k plan membership statisitcs for INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN

Measure Date Value
2022: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-0114
Total number of active participants reported on line 7a of the Form 55002022-02-0115
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-0115
Total participants2022-02-0115
2020: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-0113
Total number of active participants reported on line 7a of the Form 55002020-02-0113
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-0113
Total participants2020-02-0113
2019: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-0112
Total number of active participants reported on line 7a of the Form 55002019-02-0113
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-0113
Total participants2019-02-0113
2018: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-019
Total number of active participants reported on line 7a of the Form 55002018-02-0112
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-0112
Total participants2018-02-0112
2017: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-019
Total number of active participants reported on line 7a of the Form 55002017-02-019
Total of all active and inactive participants2017-02-019
Total participants2017-02-019
2016: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-018
Total number of active participants reported on line 7a of the Form 55002016-02-019
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-019
Total participants2016-02-019
2015: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-0110
Total number of active participants reported on line 7a of the Form 55002015-02-018
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-018
Total participants2015-02-018
2014: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-019
Total number of active participants reported on line 7a of the Form 55002014-02-019
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-019
Total participants2014-02-019
2013: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-017
Total number of active participants reported on line 7a of the Form 55002013-02-0110
Number of retired or separated participants receiving benefits2013-02-010
Number of other retired or separated participants entitled to future benefits2013-02-010
Total of all active and inactive participants2013-02-0110
Total participants2013-02-0110
2012: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-0125
Total number of active participants reported on line 7a of the Form 55002012-02-0125
Number of retired or separated participants receiving benefits2012-02-010
Number of other retired or separated participants entitled to future benefits2012-02-010
Total of all active and inactive participants2012-02-0125
Total participants2012-02-0125
2011: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-016
Total number of active participants reported on line 7a of the Form 55002011-02-016
Number of retired or separated participants receiving benefits2011-02-010
Number of other retired or separated participants entitled to future benefits2011-02-010
Total of all active and inactive participants2011-02-016
Total participants2011-02-016
2009: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-015
Total number of active participants reported on line 7a of the Form 55002009-02-015
Number of retired or separated participants receiving benefits2009-02-010
Number of other retired or separated participants entitled to future benefits2009-02-010
Total of all active and inactive participants2009-02-015
Total participants2009-02-015

Financial Data on INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN

Measure Date Value
2023 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2023 401k financial data
Total income from all sources2023-01-31$195,609
Expenses. Total of all expenses incurred2023-01-31$198,443
Benefits paid (including direct rollovers)2023-01-31$45,819
Total plan assets at end of year2023-01-31$3,702
Total plan assets at beginning of year2023-01-31$6,536
Value of fidelity bond covering the plan2023-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2023-01-31$143,031
Contributions received from other sources (not participants or employers)2023-01-31$690
Net income (gross income less expenses)2023-01-31$-2,834
Net plan assets at end of year (total assets less liabilities)2023-01-31$3,702
Net plan assets at beginning of year (total assets less liabilities)2023-01-31$6,536
Total contributions received or receivable from employer(s)2023-01-31$194,919
Expenses. Administrative service providers (salaries,fees and commissions)2023-01-31$9,593
2021 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2021 401k financial data
Total income from all sources2021-01-31$138,295
Expenses. Total of all expenses incurred2021-01-31$141,763
Benefits paid (including direct rollovers)2021-01-31$46,470
Total plan assets at end of year2021-01-31$2,219
Total plan assets at beginning of year2021-01-31$5,687
Value of fidelity bond covering the plan2021-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2021-01-31$86,453
Other income received2021-01-31$2
Net income (gross income less expenses)2021-01-31$-3,468
Net plan assets at end of year (total assets less liabilities)2021-01-31$2,219
Net plan assets at beginning of year (total assets less liabilities)2021-01-31$5,687
Total contributions received or receivable from employer(s)2021-01-31$138,293
Expenses. Administrative service providers (salaries,fees and commissions)2021-01-31$8,840
2020 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2020 401k financial data
Total income from all sources2020-01-31$346,456
Expenses. Total of all expenses incurred2020-01-31$350,418
Benefits paid (including direct rollovers)2020-01-31$266,641
Total plan assets at end of year2020-01-31$5,687
Total plan assets at beginning of year2020-01-31$9,649
Value of fidelity bond covering the plan2020-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2020-01-31$74,599
Other income received2020-01-31$29,280
Net income (gross income less expenses)2020-01-31$-3,962
Net plan assets at end of year (total assets less liabilities)2020-01-31$5,687
Net plan assets at beginning of year (total assets less liabilities)2020-01-31$9,649
Total contributions received or receivable from employer(s)2020-01-31$317,176
Expenses. Administrative service providers (salaries,fees and commissions)2020-01-31$9,178
2019 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2019 401k financial data
Total income from all sources2019-01-31$370,493
Expenses. Total of all expenses incurred2019-01-31$373,431
Benefits paid (including direct rollovers)2019-01-31$235,019
Total plan assets at end of year2019-01-31$9,649
Total plan assets at beginning of year2019-01-31$12,587
Value of fidelity bond covering the plan2019-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2019-01-31$130,941
Other income received2019-01-31$100,834
Net income (gross income less expenses)2019-01-31$-2,938
Net plan assets at end of year (total assets less liabilities)2019-01-31$9,649
Net plan assets at beginning of year (total assets less liabilities)2019-01-31$12,587
Total contributions received or receivable from employer(s)2019-01-31$269,659
Expenses. Administrative service providers (salaries,fees and commissions)2019-01-31$7,471
2018 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2018 401k financial data
Total income from all sources2018-01-31$413,971
Expenses. Total of all expenses incurred2018-01-31$408,418
Benefits paid (including direct rollovers)2018-01-31$332,872
Total plan assets at end of year2018-01-31$12,588
Total plan assets at beginning of year2018-01-31$7,035
Value of fidelity bond covering the plan2018-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2018-01-31$68,599
Other income received2018-01-31$224,407
Noncash contributions received2018-01-31$1
Net income (gross income less expenses)2018-01-31$5,553
Net plan assets at end of year (total assets less liabilities)2018-01-31$12,588
Net plan assets at beginning of year (total assets less liabilities)2018-01-31$7,035
Total contributions received or receivable from employer(s)2018-01-31$189,563
Expenses. Administrative service providers (salaries,fees and commissions)2018-01-31$6,947
2017 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2017 401k financial data
Total income from all sources2017-01-31$128,384
Expenses. Total of all expenses incurred2017-01-31$138,111
Benefits paid (including direct rollovers)2017-01-31$90,599
Total plan assets at end of year2017-01-31$7,045
Total plan assets at beginning of year2017-01-31$16,772
Value of fidelity bond covering the plan2017-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2017-01-31$42,841
Other income received2017-01-31$919
Net income (gross income less expenses)2017-01-31$-9,727
Net plan assets at end of year (total assets less liabilities)2017-01-31$7,045
Net plan assets at beginning of year (total assets less liabilities)2017-01-31$16,772
Total contributions received or receivable from employer(s)2017-01-31$127,465
Expenses. Administrative service providers (salaries,fees and commissions)2017-01-31$4,671
2016 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2016 401k financial data
Total income from all sources2016-01-31$124,094
Expenses. Total of all expenses incurred2016-01-31$132,399
Benefits paid (including direct rollovers)2016-01-31$91,262
Total plan assets at end of year2016-01-31$16,772
Total plan assets at beginning of year2016-01-31$25,077
Value of fidelity bond covering the plan2016-01-31$5,000,000
Expenses. Other expenses not covered elsewhere2016-01-31$36,402
Noncash contributions received2016-01-31$693
Net income (gross income less expenses)2016-01-31$-8,305
Net plan assets at end of year (total assets less liabilities)2016-01-31$16,772
Net plan assets at beginning of year (total assets less liabilities)2016-01-31$25,077
Total contributions received or receivable from employer(s)2016-01-31$123,401
Expenses. Administrative service providers (salaries,fees and commissions)2016-01-31$4,735
2015 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2015 401k financial data
Total income from all sources2015-01-31$170,296
Expenses. Total of all expenses incurred2015-01-31$159,234
Benefits paid (including direct rollovers)2015-01-31$96,419
Total plan assets at end of year2015-01-31$25,077
Total plan assets at beginning of year2015-01-31$14,015
Value of fidelity bond covering the plan2015-01-31$4,700,000
Expenses. Other expenses not covered elsewhere2015-01-31$57,390
Other income received2015-01-31$620
Net income (gross income less expenses)2015-01-31$11,062
Net plan assets at end of year (total assets less liabilities)2015-01-31$25,077
Net plan assets at beginning of year (total assets less liabilities)2015-01-31$14,015
Total contributions received or receivable from employer(s)2015-01-31$169,676
Expenses. Administrative service providers (salaries,fees and commissions)2015-01-31$5,425
2014 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2014 401k financial data
Total income from all sources2014-01-31$215,050
Expenses. Total of all expenses incurred2014-01-31$245,207
Benefits paid (including direct rollovers)2014-01-31$181,046
Total plan assets at end of year2014-01-31$14,015
Total plan assets at beginning of year2014-01-31$44,172
Value of fidelity bond covering the plan2014-01-31$4,700,000
Expenses. Other expenses not covered elsewhere2014-01-31$64,161
Other income received2014-01-31$860
Net income (gross income less expenses)2014-01-31$-30,157
Net plan assets at end of year (total assets less liabilities)2014-01-31$14,015
Net plan assets at beginning of year (total assets less liabilities)2014-01-31$44,172
Total contributions received or receivable from employer(s)2014-01-31$214,190
2013 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2013 401k financial data
Total income from all sources2013-01-31$275,369
Expenses. Total of all expenses incurred2013-01-31$273,749
Benefits paid (including direct rollovers)2013-01-31$206,152
Total plan assets at end of year2013-01-31$44,172
Total plan assets at beginning of year2013-01-31$42,552
Value of fidelity bond covering the plan2013-01-31$100,000
Expenses. Other expenses not covered elsewhere2013-01-31$67,597
Other income received2013-01-31$133,117
Net income (gross income less expenses)2013-01-31$1,620
Net plan assets at end of year (total assets less liabilities)2013-01-31$44,172
Net plan assets at beginning of year (total assets less liabilities)2013-01-31$42,552
Total contributions received or receivable from employer(s)2013-01-31$142,252
2012 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2012 401k financial data
Total income from all sources2012-01-31$509,751
Expenses. Total of all expenses incurred2012-01-31$474,215
Benefits paid (including direct rollovers)2012-01-31$422,665
Total plan assets at end of year2012-01-31$42,552
Total plan assets at beginning of year2012-01-31$7,016
Value of fidelity bond covering the plan2012-01-31$1,000,000
Expenses. Other expenses not covered elsewhere2012-01-31$51,550
Other income received2012-01-31$304,903
Net income (gross income less expenses)2012-01-31$35,536
Net plan assets at end of year (total assets less liabilities)2012-01-31$42,552
Net plan assets at beginning of year (total assets less liabilities)2012-01-31$7,016
Total contributions received or receivable from employer(s)2012-01-31$204,848
2011 : INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2011 401k financial data
Total income from all sources2011-01-31$349,621
Expenses. Total of all expenses incurred2011-01-31$403,911
Benefits paid (including direct rollovers)2011-01-31$354,877
Total plan assets at end of year2011-01-31$7,016
Total plan assets at beginning of year2011-01-31$61,306
Value of fidelity bond covering the plan2011-01-31$1,000,000
Expenses. Other expenses not covered elsewhere2011-01-31$49,034
Other income received2011-01-31$33,031
Net income (gross income less expenses)2011-01-31$-54,290
Net plan assets at end of year (total assets less liabilities)2011-01-31$7,016
Net plan assets at beginning of year (total assets less liabilities)2011-01-31$61,306
Total contributions received or receivable from employer(s)2011-01-31$316,590

Form 5500 Responses for INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN

2022: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – TrustYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement - TrustYes
2020: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Submission has been amendedNo
2020-02-01This submission is the final filingNo
2020-02-01This return/report is a short plan year return/report (less than 12 months)No
2020-02-01Plan is a collectively bargained planNo
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – TrustYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement - TrustYes
2019: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Submission has been amendedNo
2019-02-01This submission is the final filingNo
2019-02-01This return/report is a short plan year return/report (less than 12 months)No
2019-02-01Plan is a collectively bargained planNo
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan funding arrangement – TrustYes
2019-02-01Plan benefit arrangement – InsuranceYes
2019-02-01Plan benefit arrangement - TrustYes
2018: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)No
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – TrustYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement - TrustYes
2017: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan funding arrangement – TrustYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement - TrustYes
2016: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – TrustYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement - TrustYes
2015: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – General assets of the sponsorYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – General assets of the sponsorYes
2014: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Submission has been amendedNo
2014-02-01This submission is the final filingNo
2014-02-01This return/report is a short plan year return/report (less than 12 months)No
2014-02-01Plan is a collectively bargained planNo
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – TrustYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement - TrustYes
2013: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – TrustYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement - TrustYes
2012: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Submission has been amendedNo
2012-02-01This submission is the final filingNo
2012-02-01This return/report is a short plan year return/report (less than 12 months)No
2012-02-01Plan is a collectively bargained planNo
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – TrustYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement - TrustYes
2011: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Submission has been amendedNo
2011-02-01This submission is the final filingNo
2011-02-01This return/report is a short plan year return/report (less than 12 months)No
2011-02-01Plan is a collectively bargained planNo
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: INT HARVESTER EMP CREDIT UNION INC NON UNION EMP HLTH BEN PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedNo
2009-02-01This submission is the final filingNo
2009-02-01This return/report is a short plan year return/report (less than 12 months)No
2009-02-01Plan is a collectively bargained planNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – TrustYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered15
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of fees paid to insurance companyUSD $51
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 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 $594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees51
Additional information about fees paid to insurance brokerLIFE/AD&D FEES
Insurance broker organization code?5
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered15
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
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 $140,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered13
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $53
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 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 $611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53
Insurance broker organization code?5
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered13
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
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 $83,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered13
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
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 BenefitYes
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 $688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered13
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
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 $72,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered12
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $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 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 $68,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered12
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $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 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 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 $643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered9
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
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 $51,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered9
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
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 BenefitYes
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 $603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered8
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $42
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 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 $492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42
Insurance broker organization code?5
Insurance broker nameMEDICAL BENEFITS ADMINISTRATORS
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered8
Insurance policy start date2016-02-01
Insurance policy end date2016-01-31
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 $34,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered9
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
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 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 $626
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered10
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
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 $56,683
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered10
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $40
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 BenefitYes
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 $515
Commission paid to Insurance BrokerUSD $40
Insurance broker organization code?3
Insurance broker nameCAPTIAL PLANNING SERVICES, INC.
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered10
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $60,614
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered10
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $36
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $424
Commission paid to Insurance BrokerUSD $36
Insurance broker organization code?3
Insurance broker nameCAPITAL PLANNING SERVICES, INC.
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered6
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $44,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered6
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $31
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10142
Policy instance 2
Insurance contract or identification number10142
Number of Individuals Covered6
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $31
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $456
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10142
Policy instance 1
Insurance contract or identification number10142
Number of Individuals Covered6
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $42,212

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