ROSE-HULMAN INSTITUTE OF TECHNOLOGY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 505 | 2022-05-03 | | | | |
| 505 | 2021-05-03 | | | | |
| 505 | 2020-05-03 | | | | |
| 505 | 2019-05-03 | | | | |
| 505 | 2018-05-03 | | | | |
| 505 | 2017-05-03 | STEPHANIE LANKE | | STEPHANIE LANKE | 2019-03-15 |
| 505 | 2016-05-03 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2018-03-08 |
| 505 | 2015-05-03 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2017-01-25 |
| 505 | 2014-05-03 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2016-02-12 |
| 505 | 2013-05-03 | MATTHEW D. DAVIS, ASSOC. VP FINANCE | | MATTHEW D. DAVIS, ASSOC. VP FINANCE | 2015-02-17 |
| 505 | 2012-05-03 | MATTHEW D. DAVIS, VP FOR FINANCE | | MATTHEW D. DAVIS, VP FOR FINANCE | 2013-12-10 |
| 505 | 2011-05-03 | ROBERT A. COONS, PRESIDENT | | ROBERT A. COONS, PRESIDENT | 2013-02-13 |
| 505 | 2010-05-03 | ROBERT A. COONS, CAO | | ROBERT A. COONS, CAO | 2011-11-28 |
| 505 | 2009-05-03 | ROBERT A. COONS, CAO | | ROBERT A. COONS, CAO | 2010-11-29 |
401k plan membership statisitcs for ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-03 | 603 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-03 | 631 |
| Total of all active and inactive participants | 2022-05-03 | 631 |
| Total participants | 2022-05-03 | 631 |
| 2021: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-03 | 591 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-03 | 603 |
| Total of all active and inactive participants | 2021-05-03 | 603 |
| Total participants | 2021-05-03 | 603 |
| 2020: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-03 | 558 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-03 | 591 |
| Total of all active and inactive participants | 2020-05-03 | 591 |
| Total participants | 2020-05-03 | 591 |
| 2019: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-03 | 589 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-03 | 558 |
| Total of all active and inactive participants | 2019-05-03 | 558 |
| Total participants | 2019-05-03 | 558 |
| 2018: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-03 | 580 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-03 | 589 |
| Total of all active and inactive participants | 2018-05-03 | 589 |
| Total participants | 2018-05-03 | 589 |
| 2017: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-03 | 538 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-03 | 580 |
| Total of all active and inactive participants | 2017-05-03 | 580 |
| Total participants | 2017-05-03 | 580 |
| 2016: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-03 | 537 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-03 | 538 |
| Total of all active and inactive participants | 2016-05-03 | 538 |
| 2015: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-03 | 541 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-03 | 537 |
| Total of all active and inactive participants | 2015-05-03 | 537 |
| 2014: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-03 | 496 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-03 | 541 |
| Total of all active and inactive participants | 2014-05-03 | 541 |
| 2013: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-03 | 490 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-03 | 496 |
| Total of all active and inactive participants | 2013-05-03 | 496 |
| 2012: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-03 | 468 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-03 | 490 |
| Total of all active and inactive participants | 2012-05-03 | 490 |
| 2011: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-03 | 453 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-03 | 468 |
| Total of all active and inactive participants | 2011-05-03 | 468 |
| 2010: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-05-03 | 471 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-05-03 | 453 |
| Total of all active and inactive participants | 2010-05-03 | 453 |
| 2009: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-03 | 471 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-03 | 471 |
| Total of all active and inactive participants | 2009-05-03 | 471 |
| 2022: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-05-03 | Type of plan entity | Single employer plan |
| 2022-05-03 | Submission has been amended | No |
| 2022-05-03 | This submission is the final filing | No |
| 2022-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-03 | Plan is a collectively bargained plan | No |
| 2022-05-03 | Plan funding arrangement – Insurance | Yes |
| 2022-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2021: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-05-03 | Type of plan entity | Single employer plan |
| 2021-05-03 | Submission has been amended | No |
| 2021-05-03 | This submission is the final filing | No |
| 2021-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-03 | Plan is a collectively bargained plan | No |
| 2021-05-03 | Plan funding arrangement – Insurance | Yes |
| 2021-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2020: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-05-03 | Type of plan entity | Single employer plan |
| 2020-05-03 | Submission has been amended | No |
| 2020-05-03 | This submission is the final filing | No |
| 2020-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-05-03 | Plan is a collectively bargained plan | No |
| 2020-05-03 | Plan funding arrangement – Insurance | Yes |
| 2020-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2019: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-05-03 | Type of plan entity | Single employer plan |
| 2019-05-03 | Submission has been amended | No |
| 2019-05-03 | This submission is the final filing | No |
| 2019-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-05-03 | Plan is a collectively bargained plan | No |
| 2019-05-03 | Plan funding arrangement – Insurance | Yes |
| 2019-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2018: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-05-03 | Type of plan entity | Single employer plan |
| 2018-05-03 | Submission has been amended | No |
| 2018-05-03 | This submission is the final filing | No |
| 2018-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-05-03 | Plan is a collectively bargained plan | No |
| 2018-05-03 | Plan funding arrangement – Insurance | Yes |
| 2018-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2017: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-05-03 | Type of plan entity | Single employer plan |
| 2017-05-03 | Submission has been amended | No |
| 2017-05-03 | This submission is the final filing | No |
| 2017-05-03 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-05-03 | Plan is a collectively bargained plan | No |
| 2017-05-03 | Plan funding arrangement – Insurance | Yes |
| 2017-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2016: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-05-03 | Type of plan entity | Single employer plan |
| 2016-05-03 | Plan funding arrangement – Insurance | Yes |
| 2016-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2015: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-05-03 | Type of plan entity | Single employer plan |
| 2015-05-03 | Plan funding arrangement – Insurance | Yes |
| 2015-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2014: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-05-03 | Type of plan entity | Single employer plan |
| 2014-05-03 | Plan funding arrangement – Insurance | Yes |
| 2014-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2013: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-05-03 | Type of plan entity | Single employer plan |
| 2013-05-03 | Plan funding arrangement – Insurance | Yes |
| 2013-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2012: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-05-03 | Type of plan entity | Single employer plan |
| 2012-05-03 | Plan funding arrangement – Insurance | Yes |
| 2012-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2011: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-05-03 | Type of plan entity | Single employer plan |
| 2011-05-03 | Plan funding arrangement – Insurance | Yes |
| 2011-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2010: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-05-03 | Type of plan entity | Single employer plan |
| 2010-05-03 | Plan funding arrangement – Insurance | Yes |
| 2010-05-03 | Plan benefit arrangement – Insurance | Yes |
| 2009: ROSE-HULMAN INSTITUTE OF TECHNOLOGY AD&D TRAVEL BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-05-03 | Type of plan entity | Single employer plan |
| 2009-05-03 | This submission is the final filing | No |
| 2009-05-03 | Plan funding arrangement – Insurance | Yes |
| 2009-05-03 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ABL 963140 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 963140 | | Number of Individuals Covered | 631 | | Insurance policy start date | 2022-05-03 | | Insurance policy end date | 2023-05-02 | | Total amount of commissions paid to insurance broker | USD $135 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ABL 963140 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 963140 | | Number of Individuals Covered | 603 | | Insurance policy start date | 2021-05-03 | | Insurance policy end date | 2022-05-02 | | Total amount of commissions paid to insurance broker | USD $135 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ABL 963140 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 963140 | | Number of Individuals Covered | 591 | | Insurance policy start date | 2020-05-03 | | Insurance policy end date | 2021-05-02 | | Total amount of commissions paid to insurance broker | USD $135 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ABL 963140 |
| Policy instance | 1 |
| Insurance contract or identification number | ABL 963140 | | Number of Individuals Covered | 558 | | Insurance policy start date | 2019-05-03 | | Insurance policy end date | 2020-05-02 | | Total amount of commissions paid to insurance broker | USD $135 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 589 | | Insurance policy start date | 2018-05-03 | | Insurance policy end date | 2019-05-02 | | Total amount of commissions paid to insurance broker | USD $200 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $200 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 500 | | Insurance policy start date | 2017-05-03 | | Insurance policy end date | 2018-05-02 | | Total amount of commissions paid to insurance broker | USD $200 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | GROUP TRAVEL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 500 | | Insurance policy start date | 2015-05-03 | | Insurance policy end date | 2016-05-02 | | Total amount of commissions paid to insurance broker | USD $206 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $206 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 500 | | Insurance policy start date | 2014-05-03 | | Insurance policy end date | 2015-05-02 | | Total amount of commissions paid to insurance broker | USD $205 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $205 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 496 | | Insurance policy start date | 2013-05-03 | | Insurance policy end date | 2014-05-02 | | Total amount of commissions paid to insurance broker | USD $205 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $205 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2012-05-03 | | Insurance policy end date | 2013-05-02 | | Total amount of commissions paid to insurance broker | USD $205 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Insurance policy start date | 2011-05-03 | | Insurance policy end date | 2012-05-02 | | Total amount of commissions paid to insurance broker | USD $187 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-201011 |
| Policy instance | 1 |
| Insurance contract or identification number | ETB-201011 | | Insurance policy start date | 2010-05-03 | | Insurance policy end date | 2011-05-02 | | Total amount of commissions paid to insurance broker | USD $187 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | GROUP TRAVEL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
