CITY OF VANDALIA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CITY OF VANDALIA HEALTH INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: CITY OF VANDALIA HEALTH INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 42 |
| Total of all active and inactive participants | 2022-05-01 | 42 |
| Total participants | 2022-05-01 | 42 |
| 2021: CITY OF VANDALIA HEALTH INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 38 |
| Total of all active and inactive participants | 2021-05-01 | 38 |
| Total participants | 2021-05-01 | 38 |
| 2020: CITY OF VANDALIA HEALTH INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 38 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 1 |
| Total of all active and inactive participants | 2020-05-01 | 39 |
| Total participants | 2020-05-01 | 39 |
| 2019: CITY OF VANDALIA HEALTH INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 37 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 1 |
| Total of all active and inactive participants | 2019-05-01 | 38 |
| Total participants | 2019-05-01 | 38 |
| 2018: CITY OF VANDALIA HEALTH INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 39 |
| Total of all active and inactive participants | 2018-05-01 | 39 |
| Total participants | 2018-05-01 | 39 |
| 2017: CITY OF VANDALIA HEALTH INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 39 |
| Total of all active and inactive participants | 2017-05-01 | 39 |
| Total participants | 2017-05-01 | 39 |
| 2016: CITY OF VANDALIA HEALTH INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 39 |
| Total of all active and inactive participants | 2016-05-01 | 39 |
| Total participants | 2016-05-01 | 39 |
| 2015: CITY OF VANDALIA HEALTH INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 41 |
| Total of all active and inactive participants | 2015-05-01 | 41 |
| Total participants | 2015-05-01 | 41 |
| 2014: CITY OF VANDALIA HEALTH INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 43 |
| Total of all active and inactive participants | 2014-05-01 | 43 |
| Total participants | 2014-05-01 | 43 |
| 2013: CITY OF VANDALIA HEALTH INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 41 |
| Total of all active and inactive participants | 2013-05-01 | 41 |
| Total participants | 2013-05-01 | 41 |
| 2012: CITY OF VANDALIA HEALTH INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 38 |
| Total of all active and inactive participants | 2012-05-01 | 38 |
| Total participants | 2012-05-01 | 38 |
| 2011: CITY OF VANDALIA HEALTH INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 40 |
| Total of all active and inactive participants | 2011-05-01 | 40 |
| Total participants | 2011-05-01 | 40 |
| 2009: CITY OF VANDALIA HEALTH INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 53 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 50 |
| Total of all active and inactive participants | 2009-05-01 | 50 |
| Total participants | 2009-05-01 | 50 |
| Measure | Date | Value |
|---|
| 2023 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-04-30 | $166,242 |
| Total plan liabilities at beginning of year | 2023-04-30 | $61,923 |
| Total income from all sources | 2023-04-30 | $1,270,367 |
| Expenses. Total of all expenses incurred | 2023-04-30 | $1,320,679 |
| Benefits paid (including direct rollovers) | 2023-04-30 | $1,320,679 |
| Total plan assets at end of year | 2023-04-30 | $941,873 |
| Total plan assets at beginning of year | 2023-04-30 | $887,866 |
| Total contributions received or receivable from participants | 2023-04-30 | $127,233 |
| Other income received | 2023-04-30 | $828 |
| Net income (gross income less expenses) | 2023-04-30 | $-50,312 |
| Net plan assets at end of year (total assets less liabilities) | 2023-04-30 | $775,631 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-04-30 | $825,943 |
| Total contributions received or receivable from employer(s) | 2023-04-30 | $1,142,306 |
| 2022 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-04-30 | $61,923 |
| Total plan liabilities at beginning of year | 2022-04-30 | $73,200 |
| Total income from all sources | 2022-04-30 | $1,386,798 |
| Expenses. Total of all expenses incurred | 2022-04-30 | $1,337,116 |
| Benefits paid (including direct rollovers) | 2022-04-30 | $1,337,116 |
| Total plan assets at end of year | 2022-04-30 | $887,866 |
| Total plan assets at beginning of year | 2022-04-30 | $849,461 |
| Total contributions received or receivable from participants | 2022-04-30 | $171,605 |
| Other income received | 2022-04-30 | $665 |
| Net income (gross income less expenses) | 2022-04-30 | $49,682 |
| Net plan assets at end of year (total assets less liabilities) | 2022-04-30 | $825,943 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-04-30 | $776,261 |
| Total contributions received or receivable from employer(s) | 2022-04-30 | $1,214,528 |
| 2021 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-04-30 | $73,200 |
| Total plan liabilities at beginning of year | 2021-04-30 | $59,777 |
| Total income from all sources | 2021-04-30 | $1,220,820 |
| Expenses. Total of all expenses incurred | 2021-04-30 | $1,165,270 |
| Benefits paid (including direct rollovers) | 2021-04-30 | $1,165,270 |
| Total plan assets at end of year | 2021-04-30 | $849,461 |
| Total plan assets at beginning of year | 2021-04-30 | $780,488 |
| Total contributions received or receivable from participants | 2021-04-30 | $131,421 |
| Other income received | 2021-04-30 | $902 |
| Net income (gross income less expenses) | 2021-04-30 | $55,550 |
| Net plan assets at end of year (total assets less liabilities) | 2021-04-30 | $776,261 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-04-30 | $720,711 |
| Total contributions received or receivable from employer(s) | 2021-04-30 | $1,088,497 |
| 2020 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-04-30 | $59,777 |
| Total plan liabilities at beginning of year | 2020-04-30 | $135,917 |
| Total income from all sources | 2020-04-30 | $1,206,079 |
| Expenses. Total of all expenses incurred | 2020-04-30 | $1,112,031 |
| Benefits paid (including direct rollovers) | 2020-04-30 | $1,112,031 |
| Total plan assets at end of year | 2020-04-30 | $780,488 |
| Total plan assets at beginning of year | 2020-04-30 | $762,580 |
| Total contributions received or receivable from participants | 2020-04-30 | $123,562 |
| Other income received | 2020-04-30 | $878 |
| Net income (gross income less expenses) | 2020-04-30 | $94,048 |
| Net plan assets at end of year (total assets less liabilities) | 2020-04-30 | $720,711 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-04-30 | $626,663 |
| Total contributions received or receivable from employer(s) | 2020-04-30 | $1,081,639 |
| 2019 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-04-30 | $135,917 |
| Total plan liabilities at beginning of year | 2019-04-30 | $83,589 |
| Total income from all sources | 2019-04-30 | $1,118,946 |
| Expenses. Total of all expenses incurred | 2019-04-30 | $1,053,708 |
| Benefits paid (including direct rollovers) | 2019-04-30 | $1,053,708 |
| Total plan assets at end of year | 2019-04-30 | $762,580 |
| Total plan assets at beginning of year | 2019-04-30 | $645,014 |
| Total contributions received or receivable from participants | 2019-04-30 | $111,971 |
| Other income received | 2019-04-30 | $785 |
| Net income (gross income less expenses) | 2019-04-30 | $65,238 |
| Net plan assets at end of year (total assets less liabilities) | 2019-04-30 | $626,663 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-04-30 | $561,425 |
| Total contributions received or receivable from employer(s) | 2019-04-30 | $1,006,190 |
| 2018 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-04-30 | $83,589 |
| Total plan liabilities at beginning of year | 2018-04-30 | $74,033 |
| Total income from all sources | 2018-04-30 | $108,918 |
| Expenses. Total of all expenses incurred | 2018-04-30 | $834,996 |
| Benefits paid (including direct rollovers) | 2018-04-30 | $834,996 |
| Total plan assets at end of year | 2018-04-30 | $645,014 |
| Total plan assets at beginning of year | 2018-04-30 | $1,361,536 |
| Total contributions received or receivable from participants | 2018-04-30 | $108,051 |
| Other income received | 2018-04-30 | $867 |
| Net income (gross income less expenses) | 2018-04-30 | $-726,078 |
| Net plan assets at end of year (total assets less liabilities) | 2018-04-30 | $561,425 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-04-30 | $1,287,503 |
| 2017 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-04-30 | $74,033 |
| Total plan liabilities at beginning of year | 2017-04-30 | $73,723 |
| Total income from all sources | 2017-04-30 | $1,116,471 |
| Expenses. Total of all expenses incurred | 2017-04-30 | $830,645 |
| Benefits paid (including direct rollovers) | 2017-04-30 | $830,645 |
| Total plan assets at end of year | 2017-04-30 | $1,361,536 |
| Total plan assets at beginning of year | 2017-04-30 | $1,075,400 |
| Total contributions received or receivable from participants | 2017-04-30 | $108,247 |
| Other income received | 2017-04-30 | $1,185 |
| Net income (gross income less expenses) | 2017-04-30 | $285,826 |
| Net plan assets at end of year (total assets less liabilities) | 2017-04-30 | $1,287,503 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-04-30 | $1,001,677 |
| Total contributions received or receivable from employer(s) | 2017-04-30 | $1,007,039 |
| 2016 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-04-30 | $73,723 |
| Total plan liabilities at beginning of year | 2016-04-30 | $48,018 |
| Total income from all sources | 2016-04-30 | $1,045,308 |
| Expenses. Total of all expenses incurred | 2016-04-30 | $921,155 |
| Benefits paid (including direct rollovers) | 2016-04-30 | $921,155 |
| Total plan assets at end of year | 2016-04-30 | $1,075,400 |
| Total plan assets at beginning of year | 2016-04-30 | $925,542 |
| Total contributions received or receivable from participants | 2016-04-30 | $99,562 |
| Other income received | 2016-04-30 | $982 |
| Net income (gross income less expenses) | 2016-04-30 | $124,153 |
| Net plan assets at end of year (total assets less liabilities) | 2016-04-30 | $1,001,677 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-04-30 | $877,524 |
| Total contributions received or receivable from employer(s) | 2016-04-30 | $944,764 |
| 2015 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-04-30 | $48,018 |
| Total plan liabilities at beginning of year | 2015-04-30 | $65,307 |
| Total income from all sources | 2015-04-30 | $1,022,825 |
| Expenses. Total of all expenses incurred | 2015-04-30 | $787,882 |
| Benefits paid (including direct rollovers) | 2015-04-30 | $787,882 |
| Total plan assets at end of year | 2015-04-30 | $925,542 |
| Total plan assets at beginning of year | 2015-04-30 | $707,888 |
| Total contributions received or receivable from participants | 2015-04-30 | $103,787 |
| Other income received | 2015-04-30 | $813 |
| Net income (gross income less expenses) | 2015-04-30 | $234,943 |
| Net plan assets at end of year (total assets less liabilities) | 2015-04-30 | $877,524 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-04-30 | $642,581 |
| Total contributions received or receivable from employer(s) | 2015-04-30 | $918,225 |
| 2014 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-04-30 | $65,307 |
| Total plan liabilities at beginning of year | 2014-04-30 | $66,601 |
| Total income from all sources | 2014-04-30 | $995,660 |
| Expenses. Total of all expenses incurred | 2014-04-30 | $810,417 |
| Benefits paid (including direct rollovers) | 2014-04-30 | $810,417 |
| Total plan assets at end of year | 2014-04-30 | $707,888 |
| Total plan assets at beginning of year | 2014-04-30 | $523,939 |
| Total contributions received or receivable from participants | 2014-04-30 | $101,641 |
| Other income received | 2014-04-30 | $300 |
| Net income (gross income less expenses) | 2014-04-30 | $185,243 |
| Net plan assets at end of year (total assets less liabilities) | 2014-04-30 | $642,581 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-04-30 | $457,338 |
| Total contributions received or receivable from employer(s) | 2014-04-30 | $893,719 |
| 2013 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-04-30 | $66,601 |
| Total plan liabilities at beginning of year | 2013-04-30 | $16,332 |
| Total income from all sources | 2013-04-30 | $882,675 |
| Expenses. Total of all expenses incurred | 2013-04-30 | $741,205 |
| Benefits paid (including direct rollovers) | 2013-04-30 | $741,205 |
| Total plan assets at end of year | 2013-04-30 | $523,939 |
| Total plan assets at beginning of year | 2013-04-30 | $332,200 |
| Total contributions received or receivable from participants | 2013-04-30 | $89,567 |
| Other income received | 2013-04-30 | $217 |
| Net income (gross income less expenses) | 2013-04-30 | $141,470 |
| Net plan assets at end of year (total assets less liabilities) | 2013-04-30 | $457,338 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-04-30 | $315,868 |
| Total contributions received or receivable from employer(s) | 2013-04-30 | $792,891 |
| 2012 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-04-30 | $16,332 |
| Total plan liabilities at beginning of year | 2012-04-30 | $8,223 |
| Total income from all sources | 2012-04-30 | $844,580 |
| Expenses. Total of all expenses incurred | 2012-04-30 | $665,700 |
| Benefits paid (including direct rollovers) | 2012-04-30 | $651,242 |
| Total plan assets at end of year | 2012-04-30 | $332,200 |
| Total plan assets at beginning of year | 2012-04-30 | $145,211 |
| Total contributions received or receivable from participants | 2012-04-30 | $86,016 |
| Other income received | 2012-04-30 | $285 |
| Net income (gross income less expenses) | 2012-04-30 | $178,880 |
| Net plan assets at end of year (total assets less liabilities) | 2012-04-30 | $315,868 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-04-30 | $136,988 |
| Total contributions received or receivable from employer(s) | 2012-04-30 | $758,279 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-04-30 | $14,458 |
| 2011 : CITY OF VANDALIA HEALTH INSURANCE PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-04-30 | $8,223 |
| Total plan liabilities at beginning of year | 2011-04-30 | $24,303 |
| Total income from all sources | 2011-04-30 | $914,508 |
| Expenses. Total of all expenses incurred | 2011-04-30 | $881,759 |
| Benefits paid (including direct rollovers) | 2011-04-30 | $865,510 |
| Total plan assets at end of year | 2011-04-30 | $145,211 |
| Total plan assets at beginning of year | 2011-04-30 | $128,542 |
| Total contributions received or receivable from participants | 2011-04-30 | $90,011 |
| Other income received | 2011-04-30 | $366 |
| Net income (gross income less expenses) | 2011-04-30 | $32,749 |
| Net plan assets at end of year (total assets less liabilities) | 2011-04-30 | $136,988 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-04-30 | $104,239 |
| Total contributions received or receivable from employer(s) | 2011-04-30 | $824,131 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-04-30 | $16,249 |
| 2022: CITY OF VANDALIA HEALTH INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: CITY OF VANDALIA HEALTH INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Submission has been amended | No |
| 2021-05-01 | This submission is the final filing | No |
| 2021-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-01 | Plan is a collectively bargained plan | No |
| 2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: CITY OF VANDALIA HEALTH INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Submission has been amended | No |
| 2020-05-01 | This submission is the final filing | No |
| 2020-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-05-01 | Plan is a collectively bargained plan | No |
| 2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: CITY OF VANDALIA HEALTH INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Submission has been amended | No |
| 2019-05-01 | This submission is the final filing | No |
| 2019-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-05-01 | Plan is a collectively bargained plan | No |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: CITY OF VANDALIA HEALTH INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Submission has been amended | No |
| 2018-05-01 | This submission is the final filing | No |
| 2018-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-05-01 | Plan is a collectively bargained plan | No |
| 2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: CITY OF VANDALIA HEALTH INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Submission has been amended | No |
| 2017-05-01 | This submission is the final filing | No |
| 2017-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-05-01 | Plan is a collectively bargained plan | No |
| 2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: CITY OF VANDALIA HEALTH INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Submission has been amended | No |
| 2016-05-01 | This submission is the final filing | No |
| 2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-05-01 | Plan is a collectively bargained plan | No |
| 2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: CITY OF VANDALIA HEALTH INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Submission has been amended | No |
| 2015-05-01 | This submission is the final filing | No |
| 2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-05-01 | Plan is a collectively bargained plan | No |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: CITY OF VANDALIA HEALTH INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Submission has been amended | No |
| 2014-05-01 | This submission is the final filing | No |
| 2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-05-01 | Plan is a collectively bargained plan | No |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: CITY OF VANDALIA HEALTH INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Submission has been amended | No |
| 2013-05-01 | This submission is the final filing | No |
| 2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-05-01 | Plan is a collectively bargained plan | No |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: CITY OF VANDALIA HEALTH INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Submission has been amended | No |
| 2012-05-01 | This submission is the final filing | No |
| 2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-05-01 | Plan is a collectively bargained plan | No |
| 2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: CITY OF VANDALIA HEALTH INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Submission has been amended | No |
| 2011-05-01 | This submission is the final filing | No |
| 2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-05-01 | Plan is a collectively bargained plan | No |
| 2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: CITY OF VANDALIA HEALTH INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 914601 |
| Policy instance | 2 |
| Insurance contract or identification number | 914601 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $947 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | 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 $10,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $947 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | S00140 |
| Policy instance | 1 |
| Insurance contract or identification number | S00140 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | | 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 $301,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 914601 |
| Policy instance | 2 |
| Insurance contract or identification number | 914601 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $1,123 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | 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 $10,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,123 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | S00140 |
| Policy instance | 1 |
| Insurance contract or identification number | S00140 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 $340,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 914601 |
| Policy instance | 2 |
| Insurance contract or identification number | 914601 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $1,028 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | 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 $10,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,028 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | S00140 |
| Policy instance | 1 |
| Insurance contract or identification number | S00140 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $37,701 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 $276,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,701 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 914601 |
| Policy instance | 2 |
| Insurance contract or identification number | 914601 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $962 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | 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 $9,590 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $762 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | S00140 |
| Policy instance | 1 |
| Insurance contract or identification number | S00140 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $37,183 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 $322,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,183 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | S00140 |
| Policy instance | 1 |
| Insurance contract or identification number | S00140 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $35,050 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 $281,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,050 | | Insurance broker organization code? | 3 |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 106 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $34,550 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | 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 $277,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,550 | | Insurance broker organization code? | 3 | | Insurance broker name | RALPH GRAHAM |
|
| HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 112 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | 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 $276,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,378 | | Insurance broker organization code? | 3 | | Insurance broker name | RALPH GRAHAM |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19613 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19613 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $32,472 | | Total amount of fees paid to insurance company | USD $11,048 | | 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 $265,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,472 | | Amount paid for insurance broker fees | 11048 | | Additional information about fees paid to insurance broker | ADMINISTERING CLAIMS | | Insurance broker organization code? | 5 | | Insurance broker name | HEALTH ALLIANCE MEDICAL PLANS |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19613 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19613 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $32,472 | | Total amount of fees paid to insurance company | USD $14,472 | | 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 $261,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,472 | | Amount paid for insurance broker fees | 14742 | | Additional information about fees paid to insurance broker | ADMINISTERING CLAIMS | | Insurance broker organization code? | 5 | | Insurance broker name | HEALTH ALLIANCE MEDICAL PLANS |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19613 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19613 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $34,676 | | Total amount of fees paid to insurance company | USD $12,687 | | Health Insurance Welfare Benefit | No | | Commission paid to Insurance Broker | USD $34,676 | | Amount paid for insurance broker fees | 12687 | | Additional information about fees paid to insurance broker | ADMINISTERING CLAIMS | | Insurance broker organization code? | 5 | | Insurance broker name | HEALTH ALLIANCE MEDICAL PLANS |
|
| PERICO LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85561 ) |
| Policy contract number | PX02085 |
| Policy instance | 1 |
| Insurance contract or identification number | PX02085 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $34,429 | | Total amount of fees paid to insurance company | USD $14,458 |
|
| PERICO LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85561 ) |
| Policy contract number | PX02085 |
| Policy instance | 1 |
| Insurance contract or identification number | PX02085 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $37,925 | | Total amount of fees paid to insurance company | USD $16,495 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
