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KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 401k Plan overview

Plan NameKOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT)
Plan identification number 527

KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

KOHLER CO. & SUBSIDIARIES has sponsored the creation of one or more 401k plans.

Company Name:KOHLER CO. & SUBSIDIARIES
Employer identification number (EIN):390402810
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT)

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5272022-01-01
5272021-01-01
5272020-01-01
5272019-01-01CARLY K. WAINRIGHT2020-10-15
5272019-01-01CARLY K. WAINRIGHT2020-10-15
5272018-01-01CARLY K. WAINRIGHT2019-10-13
5272018-01-01CARLY K. WAINRIGHT2019-10-13
5272017-01-01
5272017-01-01CARLY K. WAINRIGHT
5272017-01-01
5272017-01-01
5272016-01-01
5272015-01-01CARLY K. WAINRIGHT
5272014-01-01CARLY K. WAINRIGHT
5272013-01-01CARLY WAINRIGHT CARLY WAINRIGHT2014-10-15
5272012-01-01ANNA SLIMMER
5272011-01-01ANNA SLIMMER
5272010-01-01ANNA SLIMMER
5272009-01-01ANNA SLIMMER
5272009-01-01

Plan Statistics for KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT)

401k plan membership statisitcs for KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT)

Measure Date Value
2022: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2022 401k membership
Total participants, beginning-of-year2022-01-0110,127
Total number of active participants reported on line 7a of the Form 55002022-01-0110,595
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0110,595
2021: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2021 401k membership
Total participants, beginning-of-year2021-01-019,325
Total number of active participants reported on line 7a of the Form 55002021-01-0110,127
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0110,127
2020: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2020 401k membership
Total participants, beginning-of-year2020-01-019,409
Total number of active participants reported on line 7a of the Form 55002020-01-019,325
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-019,325
2019: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2019 401k membership
Total participants, beginning-of-year2019-01-0110,044
Total number of active participants reported on line 7a of the Form 55002019-01-019,409
Total of all active and inactive participants2019-01-019,409
2018: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2018 401k membership
Total participants, beginning-of-year2018-01-019,816
Total number of active participants reported on line 7a of the Form 55002018-01-019,915
Total of all active and inactive participants2018-01-019,915
2017: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2017 401k membership
Total participants, beginning-of-year2017-01-0110,095
Total number of active participants reported on line 7a of the Form 55002017-01-019,703
Total of all active and inactive participants2017-01-019,703
2016: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2016 401k membership
Total participants, beginning-of-year2016-01-019,717
Total number of active participants reported on line 7a of the Form 55002016-01-0110,268
Total of all active and inactive participants2016-01-0110,268
2015: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2015 401k membership
Total participants, beginning-of-year2015-01-019,126
Total number of active participants reported on line 7a of the Form 55002015-01-019,409
Total of all active and inactive participants2015-01-019,409
2014: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2014 401k membership
Total participants, beginning-of-year2014-01-019,031
Total number of active participants reported on line 7a of the Form 55002014-01-019,141
Total of all active and inactive participants2014-01-019,141
2013: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2013 401k membership
Total participants, beginning-of-year2013-01-018,841
Total number of active participants reported on line 7a of the Form 55002013-01-019,058
Total of all active and inactive participants2013-01-019,058
2012: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2012 401k membership
Total participants, beginning-of-year2012-01-018,884
Total number of active participants reported on line 7a of the Form 55002012-01-018,849
Total of all active and inactive participants2012-01-018,849
2011: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2011 401k membership
Total participants, beginning-of-year2011-01-019,545
Total number of active participants reported on line 7a of the Form 55002011-01-018,907
Total of all active and inactive participants2011-01-018,907
2010: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2010 401k membership
Total participants, beginning-of-year2010-01-0110,021
Total number of active participants reported on line 7a of the Form 55002010-01-019,554
Total of all active and inactive participants2010-01-019,554
2009: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2009 401k membership
Total participants, beginning-of-year2009-01-016,045
Total number of active participants reported on line 7a of the Form 55002009-01-015,210
Total of all active and inactive participants2009-01-015,210

Form 5500 Responses for KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT)

2022: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: KOHLER CO. GROUP BENEFIT PLANS (MEDICAL, DENTAL, VISION, STD, LTD, LIFE, FSA & TRAVEL ACCIDENT) 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0238865
Policy instance 6
Insurance contract or identification number0238865
Number of Individuals Covered3009
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $104,167
Total amount of fees paid to insurance companyUSD $15,605
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,483,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $104,167
Amount paid for insurance broker fees15605
Additional information about fees paid to insurance brokerNON-MONETARY/SUPPLEMENTAL COMP. MARKETING FEES
Insurance broker organization code?3
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberN01304318
Policy instance 1
Insurance contract or identification numberN01304318
Number of Individuals Covered19333
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,208
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $61,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,208
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1427
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493
Policy instance 3
Insurance contract or identification number145493
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $31,250
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $965,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,250
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number712361
Policy instance 4
Insurance contract or identification number712361
Number of Individuals Covered7580
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $425,308
Total amount of fees paid to insurance companyUSD $74,075
Other welfare benefits providedVOLUNTARY: ACC, CCI, CI AND HCI
Welfare Benefit Premiums Paid to CarrierUSD $1,851,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $284,846
Amount paid for insurance broker fees49609
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0238047
Policy instance 5
Insurance contract or identification number0238047
Number of Individuals Covered15818
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $87
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,181,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees87
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number71236-1
Policy instance 4
Insurance contract or identification number71236-1
Number of Individuals Covered5814
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $371,223
Total amount of fees paid to insurance companyUSD $5,414
Other welfare benefits providedVOLUNTARY: ACC, CCI, CI AND HCI
Welfare Benefit Premiums Paid to CarrierUSD $1,615,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $371,223
Amount paid for insurance broker fees5414
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493
Policy instance 3
Insurance contract or identification number145493
Number of Individuals Covered13229
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $125,000
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,780,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125,000
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1501
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberN01304318
Policy instance 1
Insurance contract or identification numberN01304318
Number of Individuals Covered19278
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,763
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $48,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,763
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70236-1
Policy instance 4
Insurance contract or identification number70236-1
Number of Individuals Covered6358
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $313,077
Total amount of fees paid to insurance companyUSD $69,492
Other welfare benefits providedVOLUNTARY: ACC, CCI, CI AND HCI
Welfare Benefit Premiums Paid to CarrierUSD $1,362,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $313,077
Amount paid for insurance broker fees69492
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493
Policy instance 3
Insurance contract or identification number145493
Number of Individuals Covered3016
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $104,167
Total amount of fees paid to insurance companyUSD $50,000
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,759,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $104,167
Amount paid for insurance broker fees50000
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1589
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N01304318
Policy instance 1
Insurance contract or identification numberADD N01304318
Number of Individuals Covered9325
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,776
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $48,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,776
Insurance broker organization code?3
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N01304318
Policy instance 1
Insurance contract or identification numberADD N01304318
Number of Individuals Covered9409
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,174
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $45,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,174
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1775
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493 GIB
Policy instance 3
Insurance contract or identification number145493 GIB
Number of Individuals Covered16311
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,971,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N01304318
Policy instance 1
Insurance contract or identification numberADD N01304318
Number of Individuals Covered9915
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,174
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $45,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,174
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1737
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493 GIB
Policy instance 3
Insurance contract or identification number145493 GIB
Number of Individuals Covered17007
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,920,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number145493 GIB
Policy instance 3
Insurance contract or identification number145493 GIB
Number of Individuals Covered16798
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,789,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number01008 00000
Policy instance 2
Insurance contract or identification number01008 00000
Number of Individuals Covered1791
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberADD N01304318
Policy instance 1
Insurance contract or identification numberADD N01304318
Number of Individuals Covered9703
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,174
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $45,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,174
Insurance broker organization code?3
Insurance broker nameMERCER

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