WAUNAKEE MANOR HEALTH CARE CENTER, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN
401k plan membership statisitcs for WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2013: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 0 |
| 2012: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 154 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 154 |
| 2011: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 149 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 149 |
| 2010: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 150 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 150 |
| 2009: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 150 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 150 |
| 2008: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 137 |
| Number of retired or separated participants receiving benefits | 2008-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-01-01 | 0 |
| Total of all active and inactive participants | 2008-01-01 | 137 |
| 2007: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 123 |
| Number of retired or separated participants receiving benefits | 2007-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-01-01 | 0 |
| Total of all active and inactive participants | 2007-01-01 | 123 |
| 2006: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-10-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-10-01 | 118 |
| Number of retired or separated participants receiving benefits | 2006-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-10-01 | 0 |
| Total of all active and inactive participants | 2006-10-01 | 118 |
| 2005: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-10-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-10-01 | 127 |
| Number of retired or separated participants receiving benefits | 2005-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-10-01 | 0 |
| Total of all active and inactive participants | 2005-10-01 | 127 |
| 2004: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-10-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-10-01 | 117 |
| Number of retired or separated participants receiving benefits | 2004-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-10-01 | 0 |
| Total of all active and inactive participants | 2004-10-01 | 117 |
| 2003: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-10-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-10-01 | 125 |
| Number of retired or separated participants receiving benefits | 2003-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-10-01 | 0 |
| Total of all active and inactive participants | 2003-10-01 | 125 |
| 2002: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-10-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-10-01 | 125 |
| Number of retired or separated participants receiving benefits | 2002-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-10-01 | 0 |
| Total of all active and inactive participants | 2002-10-01 | 125 |
| 2001: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-10-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-10-01 | 118 |
| Number of retired or separated participants receiving benefits | 2001-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2001-10-01 | 0 |
| Total of all active and inactive participants | 2001-10-01 | 118 |
| 2013: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | Yes |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | Submission has been amended | No |
| 2007-01-01 | This submission is the final filing | No |
| 2007-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-01-01 | Plan is a collectively bargained plan | No |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2006 form 5500 responses |
|---|
| 2006-10-01 | Type of plan entity | Single employer plan |
| 2006-10-01 | Submission has been amended | No |
| 2006-10-01 | This submission is the final filing | No |
| 2006-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2006-10-01 | Plan is a collectively bargained plan | No |
| 2006-10-01 | Plan funding arrangement – Insurance | Yes |
| 2006-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2005 form 5500 responses |
|---|
| 2005-10-01 | Type of plan entity | Single employer plan |
| 2005-10-01 | Submission has been amended | No |
| 2005-10-01 | This submission is the final filing | No |
| 2005-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-10-01 | Plan is a collectively bargained plan | No |
| 2005-10-01 | Plan funding arrangement – Insurance | Yes |
| 2005-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2004 form 5500 responses |
|---|
| 2004-10-01 | Type of plan entity | Single employer plan |
| 2004-10-01 | Submission has been amended | No |
| 2004-10-01 | This submission is the final filing | No |
| 2004-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-10-01 | Plan is a collectively bargained plan | No |
| 2004-10-01 | Plan funding arrangement – Insurance | Yes |
| 2004-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2003 form 5500 responses |
|---|
| 2003-10-01 | Type of plan entity | Single employer plan |
| 2003-10-01 | Submission has been amended | No |
| 2003-10-01 | This submission is the final filing | No |
| 2003-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-10-01 | Plan is a collectively bargained plan | No |
| 2003-10-01 | Plan funding arrangement – Insurance | Yes |
| 2003-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2002 form 5500 responses |
|---|
| 2002-10-01 | Type of plan entity | Single employer plan |
| 2002-10-01 | Submission has been amended | No |
| 2002-10-01 | This submission is the final filing | No |
| 2002-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-10-01 | Plan is a collectively bargained plan | No |
| 2002-10-01 | Plan funding arrangement – Insurance | Yes |
| 2002-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: WAUNAKEE MANOR HEALTH CARE CENTER, INC. GROUP LIFE INSURANCE PLAN 2001 form 5500 responses |
|---|
| 2001-10-01 | Type of plan entity | Single employer plan |
| 2001-10-01 | First time form 5500 has been submitted | Yes |
| 2001-10-01 | Submission has been amended | No |
| 2001-10-01 | This submission is the final filing | No |
| 2001-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-10-01 | Plan is a collectively bargained plan | No |
| 2001-10-01 | Plan funding arrangement – Insurance | Yes |
| 2001-10-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00472761 |
| Policy instance | 1 |
| Insurance contract or identification number | 00472761 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,808 | | Total amount of fees paid to insurance company | USD $34 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $58,371 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,808 | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | TOTAL FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00472761 |
| Policy instance | 1 |
| Insurance contract or identification number | 00472761 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,420 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $65,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,420 | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| THE EPIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64149 ) |
| Policy contract number | 161777 |
| Policy instance | 1 |
| Insurance contract or identification number | 161777 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $383 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE EPIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64149 ) |
| Policy contract number | 161777 |
| Policy instance | 1 |
| Insurance contract or identification number | 161777 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $394 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $394 | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| THE EPIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64149 ) |
| Policy contract number | 161777 |
| Policy instance | 1 |
| Insurance contract or identification number | 161777 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $349 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $349 | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| THE EPIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64149 ) |
| Policy contract number | 161777 |
| Policy instance | 1 |
| Insurance contract or identification number | 161777 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $319 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $319 | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| THE EPIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64149 ) |
| Policy contract number | 161777 |
| Policy instance | 1 |
| Insurance contract or identification number | 161777 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $427 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $427 | | Insurance broker organization code? | 3 | | Insurance broker name | HEMB INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2006-10-01 | | Insurance policy end date | 2006-12-31 | | Total amount of commissions paid to insurance broker | USD $113 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $945 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $113 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2005-10-01 | | Insurance policy end date | 2006-09-30 | | Total amount of commissions paid to insurance broker | USD $349 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $349 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2004-10-01 | | Insurance policy end date | 2005-09-30 | | Total amount of commissions paid to insurance broker | USD $499 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $499 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2003-10-01 | | Insurance policy end date | 2004-09-30 | | Total amount of commissions paid to insurance broker | USD $609 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $609 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2002-10-01 | | Insurance policy end date | 2003-09-30 | | Total amount of commissions paid to insurance broker | USD $609 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $609 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | GL-6945 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-6945 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2001-10-01 | | Insurance policy end date | 2002-09-30 | | Total amount of commissions paid to insurance broker | USD $608 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $608 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGGINS INSURANCE GROUP |
|
