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WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameWESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN
Plan identification number 502

WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

WESTMINSTER VILLAGE TERRE HAUTE, INC. has sponsored the creation of one or more 401k plans.

Company Name:WESTMINSTER VILLAGE TERRE HAUTE, INC.
Employer identification number (EIN):351494162
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022019-05-01
5022019-05-01CARRIE MATHES2022-02-08
5022018-05-01
5022017-05-01CARRIE MATHES CARRIE MATHES2018-11-23
5022016-05-01HELEN HILDEBRAND HELEN HILDEBRAND2017-11-08
5022015-05-01JACOB ELLIOTT JACOB ELLIOTT2016-11-30
5022014-05-01BARRETT WAY BARRETT WAY2015-12-30
5022013-05-01BARRETT WAY BARRETT WAY2015-12-30
5022012-05-01BARRETT WAY BARRETT WAY2015-12-30
5022011-05-01BARRETT WAY BARRETT WAY2015-12-30
5022010-05-01BARRETT WAY BARRETT WAY2015-12-30
5022009-05-01BARRETT WAY BARRETT WAY2015-12-30
5022008-05-01BARRETT WAY BARRETT WAY2015-12-30
5022007-05-01BARRETT WAY BARRETT WAY2015-12-30
5022006-05-01BARRETT WAY BARRETT WAY2015-12-30
5022005-05-01BARRETT WAY BARRETT WAY2015-12-30
5022004-05-01BARRETT WAY BARRETT WAY2015-12-30
5022003-05-01BARRETT WAY BARRETT WAY2015-12-30
5022002-05-01BARRETT WAY BARRETT WAY2015-12-30

Plan Statistics for WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN

Measure Date Value
2019: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01128
Total number of active participants reported on line 7a of the Form 55002019-05-0187
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-0187
Number of employers contributing to the scheme2019-05-010
2018: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01120
Total number of active participants reported on line 7a of the Form 55002018-05-01128
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01128
2017: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01127
Total number of active participants reported on line 7a of the Form 55002017-05-01120
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01120
2016: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01102
Total number of active participants reported on line 7a of the Form 55002016-05-01126
Number of retired or separated participants receiving benefits2016-05-011
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01127
2015: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01101
Total number of active participants reported on line 7a of the Form 55002015-05-01102
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01102
2014: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01119
Total number of active participants reported on line 7a of the Form 55002014-05-01101
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01101
2013: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01116
Total number of active participants reported on line 7a of the Form 55002013-05-01119
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01119
2012: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01115
Total number of active participants reported on line 7a of the Form 55002012-05-01114
Number of retired or separated participants receiving benefits2012-05-012
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01116
2011: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-0184
Total number of active participants reported on line 7a of the Form 55002011-05-01115
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01115
2010: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-01120
Total number of active participants reported on line 7a of the Form 55002010-05-0184
Number of retired or separated participants receiving benefits2010-05-010
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-0184
2009: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01121
Total number of active participants reported on line 7a of the Form 55002009-05-01120
Number of retired or separated participants receiving benefits2009-05-010
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-01120
2008: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-05-01100
Total number of active participants reported on line 7a of the Form 55002008-05-01121
Number of retired or separated participants receiving benefits2008-05-010
Number of other retired or separated participants entitled to future benefits2008-05-010
Total of all active and inactive participants2008-05-01121
2007: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-05-01100
Total number of active participants reported on line 7a of the Form 55002007-05-01100
Number of retired or separated participants receiving benefits2007-05-010
Number of other retired or separated participants entitled to future benefits2007-05-010
Total of all active and inactive participants2007-05-01100
2006: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-05-01100
Total number of active participants reported on line 7a of the Form 55002006-05-01100
Number of retired or separated participants receiving benefits2006-05-010
Number of other retired or separated participants entitled to future benefits2006-05-010
Total of all active and inactive participants2006-05-01100
2005: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-05-01100
Total number of active participants reported on line 7a of the Form 55002005-05-01100
Number of retired or separated participants receiving benefits2005-05-010
Number of other retired or separated participants entitled to future benefits2005-05-010
Total of all active and inactive participants2005-05-01100
2004: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year2004-05-01100
Total number of active participants reported on line 7a of the Form 55002004-05-01100
Number of retired or separated participants receiving benefits2004-05-010
Number of other retired or separated participants entitled to future benefits2004-05-010
Total of all active and inactive participants2004-05-01100
2003: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year2003-05-01100
Total number of active participants reported on line 7a of the Form 55002003-05-01100
Number of retired or separated participants receiving benefits2003-05-010
Number of other retired or separated participants entitled to future benefits2003-05-010
Total of all active and inactive participants2003-05-01100
2002: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year2002-05-01100
Total number of active participants reported on line 7a of the Form 55002002-05-01100
Number of retired or separated participants receiving benefits2002-05-010
Number of other retired or separated participants entitled to future benefits2002-05-010
Total of all active and inactive participants2002-05-01100

Form 5500 Responses for WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN

2019: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – General assets of the sponsorYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – General assets of the sponsorYes
2018: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Submission has been amendedNo
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes
2008: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-05-01Type of plan entitySingle employer plan
2008-05-01Submission has been amendedNo
2008-05-01This submission is the final filingNo
2008-05-01This return/report is a short plan year return/report (less than 12 months)No
2008-05-01Plan is a collectively bargained planNo
2008-05-01Plan funding arrangement – InsuranceYes
2008-05-01Plan benefit arrangement – InsuranceYes
2007: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-05-01Type of plan entitySingle employer plan
2007-05-01Submission has been amendedNo
2007-05-01This submission is the final filingNo
2007-05-01This return/report is a short plan year return/report (less than 12 months)No
2007-05-01Plan is a collectively bargained planNo
2007-05-01Plan funding arrangement – InsuranceYes
2007-05-01Plan benefit arrangement – InsuranceYes
2006: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-05-01Type of plan entitySingle employer plan
2006-05-01Submission has been amendedNo
2006-05-01This submission is the final filingNo
2006-05-01This return/report is a short plan year return/report (less than 12 months)No
2006-05-01Plan is a collectively bargained planNo
2006-05-01Plan funding arrangement – InsuranceYes
2006-05-01Plan benefit arrangement – InsuranceYes
2005: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-05-01Type of plan entitySingle employer plan
2005-05-01Submission has been amendedNo
2005-05-01This submission is the final filingNo
2005-05-01This return/report is a short plan year return/report (less than 12 months)No
2005-05-01Plan is a collectively bargained planNo
2005-05-01Plan funding arrangement – InsuranceYes
2005-05-01Plan benefit arrangement – InsuranceYes
2004: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2004 form 5500 responses
2004-05-01Type of plan entitySingle employer plan
2004-05-01Submission has been amendedNo
2004-05-01This submission is the final filingNo
2004-05-01This return/report is a short plan year return/report (less than 12 months)No
2004-05-01Plan is a collectively bargained planNo
2004-05-01Plan funding arrangement – InsuranceYes
2004-05-01Plan benefit arrangement – InsuranceYes
2003: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2003 form 5500 responses
2003-05-01Type of plan entitySingle employer plan
2003-05-01Submission has been amendedNo
2003-05-01This submission is the final filingNo
2003-05-01This return/report is a short plan year return/report (less than 12 months)No
2003-05-01Plan is a collectively bargained planNo
2003-05-01Plan funding arrangement – InsuranceYes
2003-05-01Plan benefit arrangement – InsuranceYes
2002: WESTMINSTER VILLAGE TERRE HAUTE, INC. WELFARE BENEFIT PLAN 2002 form 5500 responses
2002-05-01Type of plan entitySingle employer plan
2002-05-01First time form 5500 has been submittedYes
2002-05-01Submission has been amendedNo
2002-05-01This submission is the final filingNo
2002-05-01This return/report is a short plan year return/report (less than 12 months)No
2002-05-01Plan is a collectively bargained planNo
2002-05-01Plan funding arrangement – InsuranceYes
2002-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1092740
Policy instance 1
Insurance contract or identification number1092740
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFFN96
Policy instance 2
Insurance contract or identification numberFFN96
Number of Individuals Covered38
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $7,115
Total amount of fees paid to insurance companyUSD $618
Other welfare benefits providedVOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to CarrierUSD $38,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,610
Amount paid for insurance broker fees442
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1092740
Policy instance 1
Insurance contract or identification number1092740
Number of Individuals Covered203
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $6,470
Total amount of fees paid to insurance companyUSD $1,298
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $70,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,559
Amount paid for insurance broker fees1298
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00046828
Policy instance 2
Insurance contract or identification number00046828
Number of Individuals Covered115
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $24,120
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $866,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,416
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFFN96
Policy instance 3
Insurance contract or identification numberFFN96
Number of Individuals Covered52
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $8,490
Total amount of fees paid to insurance companyUSD $40
Other welfare benefits providedVOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to CarrierUSD $35,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,397
Amount paid for insurance broker fees28
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00370290
Policy instance 1
Insurance contract or identification number00370290
Number of Individuals Covered120
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $7,288
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $74,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,288
Insurance broker organization code?3
Insurance broker nameSYCAMORE INSURANCE ASSOCIATES
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00046828
Policy instance 2
Insurance contract or identification number00046828
Number of Individuals Covered91
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $29,643
Total amount of fees paid to insurance companyUSD $14
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $749,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,643
Amount paid for insurance broker fees6
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameONI RISK PARTNERS INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberFFN96
Policy instance 3
Insurance contract or identification numberFFN96
Number of Individuals Covered36
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $7,373
Total amount of fees paid to insurance companyUSD $33
Other welfare benefits providedVOLUNTARY WORKSITE BENEFITS
Welfare Benefit Premiums Paid to CarrierUSD $25,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,890
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameJOHN D TYLER

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