HOSTMARK MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2016 : HOSTMARK HEALTH CARE PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $411,314 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $655,702 |
| Total income from all sources (including contributions) | 2016-12-31 | $4,518,113 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $4,330,170 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $4,209,908 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $4,518,113 |
| Value of total assets at end of year | 2016-12-31 | $2,103,169 |
| Value of total assets at beginning of year | 2016-12-31 | $2,159,614 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $120,262 |
| Total interest from all sources | 2016-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $1,062,065 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $268,963 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $178,009 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $558 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $70,409 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $9,025 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $293,249 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $187,943 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $1,691,855 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $1,503,912 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $928,324 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $3,456,048 |
| Employer contributions (assets) at end of year | 2016-12-31 | $1,834,206 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $1,688,356 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $3,281,584 |
| Contract administrator fees | 2016-12-31 | $120,262 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $340,905 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $646,119 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | R.J. AUGUSTINE AND ASSOCIATES, LTD |
| Accountancy firm EIN | 2016-12-31 | 363657241 |
| 2015 : HOSTMARK HEALTH CARE PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $655,702 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $204,939 |
| Total income from all sources (including contributions) | 2015-12-31 | $4,579,704 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $4,325,456 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $4,182,670 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $4,579,704 |
| Value of total assets at end of year | 2015-12-31 | $2,159,614 |
| Value of total assets at beginning of year | 2015-12-31 | $1,454,603 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $142,786 |
| Total interest from all sources | 2015-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $1,275,265 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $178,009 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $45,829 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $558 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $1,968 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $9,025 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $19,873 |
| Total non interest bearing cash at end of year | 2015-12-31 | $293,249 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $136,310 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $254,248 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $1,503,912 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $1,249,664 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $870,535 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $3,304,439 |
| Employer contributions (assets) at end of year | 2015-12-31 | $1,688,356 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $1,272,464 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $3,312,135 |
| Contract administrator fees | 2015-12-31 | $142,786 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $646,119 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $183,098 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | R.J. AUGUSTINE AND ASSOCIATES, LTD |
| Accountancy firm EIN | 2015-12-31 | 363657241 |
| 2014 : HOSTMARK HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $21,841 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $11,603 |
| Total income from all sources (including contributions) | 2014-12-31 | $4,134,803 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $3,947,676 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $3,865,345 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $4,134,803 |
| Value of total assets at end of year | 2014-12-31 | $1,454,603 |
| Value of total assets at beginning of year | 2014-12-31 | $1,257,238 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $82,331 |
| Total interest from all sources | 2014-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $1,146,528 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $45,829 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $19,237 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $1,968 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $1,428 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $19,873 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $10,175 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $187,127 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $1,432,762 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $1,245,635 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $136,310 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $77,423 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $77,423 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $854,249 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $2,988,275 |
| Employer contributions (assets) at end of year | 2014-12-31 | $1,272,464 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $1,160,578 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $3,011,096 |
| Contract administrator fees | 2014-12-31 | $82,331 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | R.J. AUGUSTINE |
| Accountancy firm EIN | 2014-12-31 | 363657241 |
| 2013 : HOSTMARK HEALTH CARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $11,603 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $85,366 |
| Total income from all sources (including contributions) | 2013-12-31 | $4,440,776 |
| Total of all expenses incurred | 2013-12-31 | $5,325,185 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $5,251,255 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $4,440,776 |
| Value of total assets at end of year | 2013-12-31 | $1,257,238 |
| Value of total assets at beginning of year | 2013-12-31 | $2,215,410 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $73,930 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $1,404,152 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $19,237 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $32,499 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $1,428 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $455 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $10,175 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $84,911 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-884,409 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $1,245,635 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $2,130,044 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $77,423 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $158,789 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $158,789 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $961,571 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $3,036,624 |
| Employer contributions (assets) at end of year | 2013-12-31 | $1,160,578 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $2,024,122 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $4,289,684 |
| Contract administrator fees | 2013-12-31 | $73,930 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | R.J. AUGUSTINE & ASSOCIATES |
| Accountancy firm EIN | 2013-12-31 | 363657241 |
| 2012 : HOSTMARK HEALTH CARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $775,160 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $397,744 |
| Total income from all sources (including contributions) | 2012-12-31 | $4,109,663 |
| Total of all expenses incurred | 2012-12-31 | $5,016,863 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $4,787,511 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $4,109,653 |
| Value of total assets at end of year | 2012-12-31 | $2,234,121 |
| Value of total assets at beginning of year | 2012-12-31 | $2,763,905 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $229,352 |
| Total interest from all sources | 2012-12-31 | $10 |
| Administrative expenses professional fees incurred | 2012-12-31 | $3,750 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $1,075,445 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $23,736 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $105,743 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $104,077 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $41,833 |
| Administrative expenses (other) incurred | 2012-12-31 | $79,388 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-907,200 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $1,458,961 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,366,161 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $158,789 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $289,718 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $289,718 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $10 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $744,732 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $3,034,208 |
| Employer contributions (assets) at end of year | 2012-12-31 | $2,051,596 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $2,368,444 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $4,042,779 |
| Contract administrator fees | 2012-12-31 | $146,214 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $671,083 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $355,911 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | RC HOFMEIER ASSOCIATES |
| Accountancy firm EIN | 2012-12-31 | 363745280 |
| 2011 : HOSTMARK HEALTH CARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $397,744 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $499,050 |
| Total income from all sources (including contributions) | 2011-12-31 | $4,046,268 |
| Total of all expenses incurred | 2011-12-31 | $3,353,058 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $3,108,761 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $4,046,265 |
| Value of total assets at end of year | 2011-12-31 | $2,763,905 |
| Value of total assets at beginning of year | 2011-12-31 | $2,172,001 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $244,297 |
| Total interest from all sources | 2011-12-31 | $3 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $3,500 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $851,707 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $105,743 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $82,097 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $41,833 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $111,331 |
| Administrative expenses (other) incurred | 2011-12-31 | $70,570 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $693,210 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $2,366,161 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,672,951 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $289,718 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $35,731 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $35,731 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $3 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $426,083 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $3,194,558 |
| Employer contributions (assets) at end of year | 2011-12-31 | $2,368,444 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $2,054,173 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $2,682,678 |
| Contract administrator fees | 2011-12-31 | $170,227 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $355,911 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $387,719 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | RC HOFMEIER ASSOCIATES |
| Accountancy firm EIN | 2011-12-31 | 363745280 |
| 2010 : HOSTMARK HEALTH CARE PLAN 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $499,050 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $505,841 |
| Total income from all sources (including contributions) | 2010-12-31 | $3,352,414 |
| Total of all expenses incurred | 2010-12-31 | $2,971,060 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $2,774,257 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $3,352,412 |
| Value of total assets at end of year | 2010-12-31 | $2,172,001 |
| Value of total assets at beginning of year | 2010-12-31 | $1,797,438 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $196,803 |
| Total interest from all sources | 2010-12-31 | $2 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $692,640 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $290,881 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $285,121 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $111,331 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $42,463 |
| Administrative expenses (other) incurred | 2010-12-31 | $29,758 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $157,277 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $381,354 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $1,672,951 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $1,291,597 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $54,827 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $35,731 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $25,844 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $25,844 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $2 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $394,328 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $2,659,772 |
| Employer contributions (assets) at end of year | 2010-12-31 | $1,845,389 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $1,486,473 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $2,379,929 |
| Contract administrator fees | 2010-12-31 | $112,218 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $387,719 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $306,101 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | RCHOFMEIER ASSOCIATES |
| Accountancy firm EIN | 2010-12-31 | 363745280 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5464686 |
| Policy instance | 2 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 402 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $21,983 | | Total amount of fees paid to insurance company | USD $528 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $264,880 | | Commission paid to Insurance Broker | USD $21,983 | | Amount paid for insurance broker fees | 528 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67567-9 |
| Policy instance | 6 |
| Insurance contract or identification number | 67567-9 | | Number of Individuals Covered | 358 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $109,988 | | Total amount of fees paid to insurance company | USD $20,787 | | 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 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $733,253 | | Amount paid for insurance broker fees | 20787 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $109,988 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNION SECURITY DENTALCARE OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11244 ) |
| Policy contract number | 5464686 |
| Policy instance | 5 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $57 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $57 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 ) |
| Policy contract number | 5464686 |
| Policy instance | 4 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $400 | | Total amount of fees paid to insurance company | USD $3 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,359 | | Commission paid to Insurance Broker | USD $400 | | Amount paid for insurance broker fees | 3 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 ) |
| Policy contract number | 5464686 |
| Policy instance | 3 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $60 | | Commission paid to Insurance Broker | USD $6 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 207201 |
| Policy instance | 8 |
| Insurance contract or identification number | 207201 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,600 | | Total amount of fees paid to insurance company | USD $510 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $40,784 | | Commission paid to Insurance Broker | USD $4,600 | | Amount paid for insurance broker fees | 510 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30011522 |
| Policy instance | 1 |
| Insurance contract or identification number | 30011522 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,673 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,577 | | Commission paid to Insurance Broker | USD $1,673 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 207199 |
| Policy instance | 7 |
| Insurance contract or identification number | 207199 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,824 | | Total amount of fees paid to insurance company | USD $755 | | 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 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 | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $60,358 | | Commission paid to Insurance Broker | USD $5,824 | | Amount paid for insurance broker fees | 755 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 207200 |
| Policy instance | 9 |
| Insurance contract or identification number | 207200 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $9,558 | | Total amount of fees paid to insurance company | USD $797 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $63,723 | | Commission paid to Insurance Broker | USD $9,558 | | Amount paid for insurance broker fees | 797 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12201947 |
| Policy instance | 3 |
| Insurance contract or identification number | 12201947 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $648 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $648 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY, LTD. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 207199 |
| Policy instance | 5 |
| Insurance contract or identification number | 207199 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,147 | | 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 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $83,976 | | Commission paid to Insurance Broker | USD $7,147 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD. |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 602789 |
| Policy instance | 1 |
| Insurance contract or identification number | 602789 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $23,909 | | Total amount of fees paid to insurance company | USD $6,063 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $239,717 | | Commission paid to Insurance Broker | USD $1,520 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6063 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 417002411125 |
| Policy instance | 7 |
| Insurance contract or identification number | 417002411125 | | Number of Individuals Covered | 388 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $718,414 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 207201 |
| Policy instance | 6 |
| Insurance contract or identification number | 207201 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,295 | | 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 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $47,791 | | Commission paid to Insurance Broker | USD $5,295 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD. |
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| UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 ) |
| Policy contract number | 5464686 |
| Policy instance | 2 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $253 | | Total amount of fees paid to insurance company | USD $47 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,612 | | Commission paid to Insurance Broker | USD $233 | | Amount paid for insurance broker fees | 47 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD. |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 2070200 |
| Policy instance | 4 |
| Insurance contract or identification number | 2070200 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $12,630 | | 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 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $84,197 | | Commission paid to Insurance Broker | USD $12,630 | | Insurance broker organization code? | 3 | | Insurance broker name | ASSURANCE AGENCY LTD. |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 207199 |
| Policy instance | 3 |
| Insurance contract or identification number | 207199 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $33,292 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $205,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,292 | | Insurance broker organization code? | 3 | | Insurance broker name | UNUM LIFE INSURANCE COMPANY |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 602789 |
| Policy instance | 2 |
| Insurance contract or identification number | 602789 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $631 | | Total amount of fees paid to insurance company | USD $74 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $631 | | Amount paid for insurance broker fees | 74 | | Insurance broker name | ASSURANCE AGENCY LTD |
|
| UNION SECURITY CARRIER (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5464686 |
| Policy instance | 1 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 457 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $29,749 | | Total amount of fees paid to insurance company | USD $90 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $811,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,749 | | Amount paid for insurance broker fees | 90 | | Insurance broker name | DIGITAL INSURANCE INC. |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 417002411125 |
| Policy instance | 4 |
| Insurance contract or identification number | 417002411125 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | RELIASTAR LIFE INSURANCE COMPANY |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 602789 |
| Policy instance | 1 |
| Insurance contract or identification number | 602789 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $20,904 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $209,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,663 | | Insurance broker name | DIGITAL INSURANCE INC |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5464686 |
| Policy instance | 2 |
| Insurance contract or identification number | 5464686 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,009 | | Total amount of fees paid to insurance company | USD $306 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,009 | | Amount paid for insurance broker fees | 306 | | Insurance broker name | DIGITAL INSURANCE INC |
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| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 190629 |
| Policy instance | 1 |
| Insurance contract or identification number | 190629 | | Number of Individuals Covered | 388 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,589 | | Total amount of fees paid to insurance company | USD $51,356 | | Health Insurance Welfare Benefit | Yes |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 182081, 300615, |
| Policy instance | 2 |
| Insurance contract or identification number | 182081, 300615, | | Number of Individuals Covered | 470 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $18,699 | | Life Insurance Welfare Benefit | Yes |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12201947 AND 30 |
| Policy instance | 3 |
| Insurance contract or identification number | 12201947 AND 30 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,848 | | Vision Insurance Welfare Benefit | Yes |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | PC 00602789 |
| Policy instance | 4 |
| Insurance contract or identification number | PC 00602789 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $19,922 | | Health Insurance Welfare Benefit | Yes |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 190629 |
| Policy instance | 1 |
| Insurance contract or identification number | 190629 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $42,196 | | Health Insurance Welfare Benefit | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 859801G |
| Policy instance | 2 |
| Insurance contract or identification number | 859801G | | Number of Individuals Covered | 309 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,630 | | Total amount of fees paid to insurance company | USD $210 | | Life Insurance Welfare Benefit | Yes |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12201947 |
| Policy instance | 3 |
| Insurance contract or identification number | 12201947 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $5,299 | | Total amount of fees paid to insurance company | USD $520 | | Vision Insurance Welfare Benefit | Yes |
|
