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IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan NameIMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number 501

IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

IMMEDIATE HEALTH ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.

Company Name:IMMEDIATE HEALTH ASSOCIATES, INC.
Employer identification number (EIN):311204097
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about IMMEDIATE HEALTH ASSOCIATES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1987-04-10
Company Identification Number: 698907
Legal Registered Office Address: 575 COPELAND MILL RD
SUITE 1D
WESTERVILLE
United States of America (USA)
43081

More information about IMMEDIATE HEALTH ASSOCIATES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-03-01
5012022-03-01
5012021-03-01
5012020-03-01
5012019-03-01
5012018-03-01
5012017-03-01KIRK HUMMER KIRK HUMMER2018-10-03
5012016-03-01KIRK HUMMER KIRK HUMMER2017-09-20
5012015-03-01KIRK HUMMER KIRK HUMMER2016-08-31
5012014-03-01KIRK HUMMER2015-12-11 KIRK HUMMER2015-12-11

Plan Statistics for IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2023: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-03-0148
Total number of active participants reported on line 7a of the Form 55002023-03-0149
Total of all active and inactive participants2023-03-0149
Total participants2023-03-0149
2022: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-03-0155
Total number of active participants reported on line 7a of the Form 55002022-03-0148
Number of retired or separated participants receiving benefits2022-03-010
Number of other retired or separated participants entitled to future benefits2022-03-010
Total of all active and inactive participants2022-03-0148
Total participants2022-03-0148
2021: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-03-0158
Total number of active participants reported on line 7a of the Form 55002021-03-0155
Number of retired or separated participants receiving benefits2021-03-010
Number of other retired or separated participants entitled to future benefits2021-03-010
Total of all active and inactive participants2021-03-0155
Total participants2021-03-0155
2020: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-03-0170
Total number of active participants reported on line 7a of the Form 55002020-03-0167
Number of retired or separated participants receiving benefits2020-03-010
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-0167
Total participants2020-03-0167
2019: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-0170
Total number of active participants reported on line 7a of the Form 55002019-03-0170
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-0170
Total participants2019-03-0170
2018: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-0170
Total number of active participants reported on line 7a of the Form 55002018-03-0170
Number of retired or separated participants receiving benefits2018-03-010
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-0170
Total participants2018-03-0170
2017: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-0197
Total number of active participants reported on line 7a of the Form 55002017-03-0170
Total of all active and inactive participants2017-03-0170
Total participants2017-03-0170
2016: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-0194
Total number of active participants reported on line 7a of the Form 55002016-03-0197
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-0197
Total participants2016-03-0197
2015: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-0192
Total number of active participants reported on line 7a of the Form 55002015-03-0194
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-0194
Total participants2015-03-0194
2014: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-0186
Total number of active participants reported on line 7a of the Form 55002014-03-0191
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-0191
Total participants2014-03-0191

Financial Data on IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2024 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2024 401k financial data
Total income from all sources2024-02-29$1,396,449
Expenses. Total of all expenses incurred2024-02-29$1,356,188
Benefits paid (including direct rollovers)2024-02-29$959,738
Total plan assets at end of year2024-02-29$225,320
Total plan assets at beginning of year2024-02-29$185,059
Total contributions received or receivable from participants2024-02-29$231,421
Expenses. Other expenses not covered elsewhere2024-02-29$355,421
Contributions received from other sources (not participants or employers)2024-02-29$96,325
Net income (gross income less expenses)2024-02-29$40,261
Net plan assets at end of year (total assets less liabilities)2024-02-29$225,320
Net plan assets at beginning of year (total assets less liabilities)2024-02-29$185,059
Total contributions received or receivable from employer(s)2024-02-29$1,068,703
Expenses. Administrative service providers (salaries,fees and commissions)2024-02-29$41,029
2023 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2023 401k financial data
Total income from all sources2023-02-28$945,044
Expenses. Total of all expenses incurred2023-02-28$1,005,846
Benefits paid (including direct rollovers)2023-02-28$610,802
Total plan assets at end of year2023-02-28$185,059
Total plan assets at beginning of year2023-02-28$245,861
Total contributions received or receivable from participants2023-02-28$256,330
Expenses. Other expenses not covered elsewhere2023-02-28$360,310
Contributions received from other sources (not participants or employers)2023-02-28$30,854
Net income (gross income less expenses)2023-02-28$-60,802
Net plan assets at end of year (total assets less liabilities)2023-02-28$185,059
Net plan assets at beginning of year (total assets less liabilities)2023-02-28$245,861
Total contributions received or receivable from employer(s)2023-02-28$657,860
Expenses. Administrative service providers (salaries,fees and commissions)2023-02-28$34,734
2022 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-02-28$1,661,453
Expenses. Total of all expenses incurred2022-02-28$1,650,062
Benefits paid (including direct rollovers)2022-02-28$1,219,503
Total plan assets at end of year2022-02-28$245,861
Total plan assets at beginning of year2022-02-28$234,470
Total contributions received or receivable from participants2022-02-28$272,496
Expenses. Other expenses not covered elsewhere2022-02-28$395,105
Other income received2022-02-28$176,396
Net income (gross income less expenses)2022-02-28$11,391
Net plan assets at end of year (total assets less liabilities)2022-02-28$245,861
Net plan assets at beginning of year (total assets less liabilities)2022-02-28$234,470
Total contributions received or receivable from employer(s)2022-02-28$1,212,561
Expenses. Administrative service providers (salaries,fees and commissions)2022-02-28$35,454
2021 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-02-28$1,528,991
Expenses. Total of all expenses incurred2021-02-28$1,457,241
Benefits paid (including direct rollovers)2021-02-28$928,251
Total plan assets at end of year2021-02-28$234,470
Total plan assets at beginning of year2021-02-28$162,720
Total contributions received or receivable from participants2021-02-28$308,331
Expenses. Other expenses not covered elsewhere2021-02-28$484,729
Other income received2021-02-28$311,304
Net income (gross income less expenses)2021-02-28$71,750
Net plan assets at end of year (total assets less liabilities)2021-02-28$234,470
Net plan assets at beginning of year (total assets less liabilities)2021-02-28$162,720
Total contributions received or receivable from employer(s)2021-02-28$909,356
Expenses. Administrative service providers (salaries,fees and commissions)2021-02-28$44,261
2020 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-02-29$1,555,807
Expenses. Total of all expenses incurred2020-02-29$1,499,075
Benefits paid (including direct rollovers)2020-02-29$1,057,393
Total plan assets at end of year2020-02-29$162,720
Total plan assets at beginning of year2020-02-29$105,988
Total contributions received or receivable from participants2020-02-29$258,900
Expenses. Other expenses not covered elsewhere2020-02-29$395,573
Other income received2020-02-29$481,034
Net income (gross income less expenses)2020-02-29$56,732
Net plan assets at end of year (total assets less liabilities)2020-02-29$162,720
Net plan assets at beginning of year (total assets less liabilities)2020-02-29$105,988
Total contributions received or receivable from employer(s)2020-02-29$815,873
Expenses. Administrative service providers (salaries,fees and commissions)2020-02-29$46,109
2019 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k financial data
Total income from all sources2019-02-28$735,910
Expenses. Total of all expenses incurred2019-02-28$821,052
Benefits paid (including direct rollovers)2019-02-28$449,267
Total plan assets at end of year2019-02-28$105,988
Total plan assets at beginning of year2019-02-28$191,130
Total contributions received or receivable from participants2019-02-28$228,830
Expenses. Other expenses not covered elsewhere2019-02-28$327,569
Other income received2019-02-28$46,008
Net income (gross income less expenses)2019-02-28$-85,142
Net plan assets at end of year (total assets less liabilities)2019-02-28$105,988
Net plan assets at beginning of year (total assets less liabilities)2019-02-28$191,130
Total contributions received or receivable from employer(s)2019-02-28$461,072
Expenses. Administrative service providers (salaries,fees and commissions)2019-02-28$44,216
2018 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-02-28$1,038,213
Expenses. Total of all expenses incurred2018-02-28$954,037
Benefits paid (including direct rollovers)2018-02-28$567,587
Total plan assets at end of year2018-02-28$191,129
Total plan assets at beginning of year2018-02-28$106,953
Total contributions received or receivable from participants2018-02-28$232,688
Expenses. Other expenses not covered elsewhere2018-02-28$335,860
Net income (gross income less expenses)2018-02-28$84,176
Net plan assets at end of year (total assets less liabilities)2018-02-28$191,129
Net plan assets at beginning of year (total assets less liabilities)2018-02-28$106,953
Total contributions received or receivable from employer(s)2018-02-28$805,525
Expenses. Administrative service providers (salaries,fees and commissions)2018-02-28$50,590
2017 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-02-28$1,012,061
Expenses. Total of all expenses incurred2017-02-28$1,018,135
Benefits paid (including direct rollovers)2017-02-28$562,509
Total plan assets at end of year2017-02-28$106,953
Total plan assets at beginning of year2017-02-28$113,027
Total contributions received or receivable from participants2017-02-28$261,164
Expenses. Other expenses not covered elsewhere2017-02-28$397,976
Other income received2017-02-28$72,133
Net income (gross income less expenses)2017-02-28$-6,074
Net plan assets at end of year (total assets less liabilities)2017-02-28$106,953
Net plan assets at beginning of year (total assets less liabilities)2017-02-28$113,027
Total contributions received or receivable from employer(s)2017-02-28$678,764
Expenses. Administrative service providers (salaries,fees and commissions)2017-02-28$57,650
2016 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k financial data
Total income from all sources2016-02-29$1,325,365
Expenses. Total of all expenses incurred2016-02-29$1,319,960
Benefits paid (including direct rollovers)2016-02-29$918,346
Total plan assets at end of year2016-02-29$113,028
Total plan assets at beginning of year2016-02-29$107,623
Total contributions received or receivable from participants2016-02-29$163,237
Expenses. Other expenses not covered elsewhere2016-02-29$346,725
Contributions received from other sources (not participants or employers)2016-02-29$199,291
Net income (gross income less expenses)2016-02-29$5,405
Net plan assets at end of year (total assets less liabilities)2016-02-29$113,028
Net plan assets at beginning of year (total assets less liabilities)2016-02-29$107,623
Total contributions received or receivable from employer(s)2016-02-29$962,837
Expenses. Administrative service providers (salaries,fees and commissions)2016-02-29$54,889
2015 : IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-02-28$983,974
Expenses. Total of all expenses incurred2015-02-28$876,351
Benefits paid (including direct rollovers)2015-02-28$487,594
Total plan assets at end of year2015-02-28$107,623
Total plan assets at beginning of year2015-02-28$0
Total contributions received or receivable from participants2015-02-28$45,371
Expenses. Other expenses not covered elsewhere2015-02-28$360,198
Other income received2015-02-28$55,128
Net income (gross income less expenses)2015-02-28$107,623
Net plan assets at end of year (total assets less liabilities)2015-02-28$107,623
Net plan assets at beginning of year (total assets less liabilities)2015-02-28$0
Total contributions received or receivable from employer(s)2015-02-28$883,475
Expenses. Administrative service providers (salaries,fees and commissions)2015-02-28$28,559

Form 5500 Responses for IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN

2023: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2023 form 5500 responses
2023-03-01Type of plan entitySingle employer plan
2023-03-01Submission has been amendedNo
2023-03-01This submission is the final filingNo
2023-03-01This return/report is a short plan year return/report (less than 12 months)No
2023-03-01Plan is a collectively bargained planNo
2023-03-01Plan funding arrangement – InsuranceYes
2023-03-01Plan funding arrangement – General assets of the sponsorYes
2023-03-01Plan benefit arrangement – InsuranceYes
2023-03-01Plan benefit arrangement – General assets of the sponsorYes
2022: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-03-01Type of plan entitySingle employer plan
2022-03-01Submission has been amendedNo
2022-03-01This submission is the final filingNo
2022-03-01This return/report is a short plan year return/report (less than 12 months)No
2022-03-01Plan is a collectively bargained planNo
2022-03-01Plan funding arrangement – InsuranceYes
2022-03-01Plan funding arrangement – General assets of the sponsorYes
2022-03-01Plan benefit arrangement – InsuranceYes
2022-03-01Plan benefit arrangement – General assets of the sponsorYes
2021: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-03-01Type of plan entitySingle employer plan
2021-03-01Submission has been amendedNo
2021-03-01This submission is the final filingNo
2021-03-01This return/report is a short plan year return/report (less than 12 months)No
2021-03-01Plan is a collectively bargained planNo
2021-03-01Plan funding arrangement – InsuranceYes
2021-03-01Plan funding arrangement – General assets of the sponsorYes
2021-03-01Plan benefit arrangement – InsuranceYes
2021-03-01Plan benefit arrangement – General assets of the sponsorYes
2020: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-03-01Type of plan entitySingle employer plan
2020-03-01Submission has been amendedNo
2020-03-01This submission is the final filingNo
2020-03-01This return/report is a short plan year return/report (less than 12 months)No
2020-03-01Plan is a collectively bargained planNo
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – General assets of the sponsorYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement – General assets of the sponsorYes
2019: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01Submission has been amendedNo
2019-03-01This submission is the final filingNo
2019-03-01This return/report is a short plan year return/report (less than 12 months)No
2019-03-01Plan is a collectively bargained planNo
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – General assets of the sponsorYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – General assets of the sponsorYes
2018: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Submission has been amendedNo
2018-03-01This submission is the final filingNo
2018-03-01This return/report is a short plan year return/report (less than 12 months)No
2018-03-01Plan is a collectively bargained planNo
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan funding arrangement – General assets of the sponsorYes
2018-03-01Plan benefit arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – General assets of the sponsorYes
2017: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Submission has been amendedNo
2017-03-01This submission is the final filingNo
2017-03-01This return/report is a short plan year return/report (less than 12 months)No
2017-03-01Plan is a collectively bargained planNo
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – General assets of the sponsorYes
2016: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – General assets of the sponsorYes
2015: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – General assets of the sponsorYes
2014: IMMEDIATE HEALTH ASSOCIATES, INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01First time form 5500 has been submittedYes
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered49
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
Total amount of commissions paid to insurance brokerUSD $156
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
Other welfare benefits providedACCIDENT, DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered49
Insurance policy start date2023-03-01
Insurance policy end date2024-02-29
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 $352,246
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 number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered48
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $173
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 $3,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $173
Insurance broker organization code?3
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered48
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
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 $348,421
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 number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered55
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $184
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 $3,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $184
Insurance broker organization code?3
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered55
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
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 $383,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered67
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
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 $470,210
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 number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered67
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $213
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 $4,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $213
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $224
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 $4,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $224
Insurance broker organization code?5
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
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 $380,997
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 number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $204
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 $3,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $204
Insurance broker organization code?3
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
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 $313,235
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 number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $211
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 $4,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $211
Insurance broker organization code?3
Insurance broker nameTHE STAEBLER GROUP
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered70
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
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 $320,950
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 number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered94
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $248
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 $4,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $248
Insurance broker organization code?5
Insurance broker nameTHE STAEBLER GROUP
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered94
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $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 $323,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10429
Policy instance 2
Insurance contract or identification number10429
Number of Individuals Covered91
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
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 $301,555
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10429
Policy instance 1
Insurance contract or identification number10429
Number of Individuals Covered91
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $255
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 $4,926
Commission paid to Insurance BrokerUSD $255
Insurance broker organization code?3
Insurance broker nameTHE STAEBLER GROUP

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