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WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 401k Plan overview

Plan NameWESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN
Plan identification number 501

WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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

401k Sponsoring company profile

WESTERN NATIONAL MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:WESTERN NATIONAL MUTUAL INSURANCE COMPANY
Employer identification number (EIN):410430825
NAIC Classification:524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01SHARON STERRIKER SHARON STERRIKER2018-07-24
5012016-01-01SHARON STERRIKER
5012015-01-01SHARON STERRIKER
5012014-01-01SHARON STERRIKER SHARON STERRIKER2015-07-30
5012013-01-01VIRGINIA LATOCKI VIRGINIA LATOCKI2014-07-24
5012012-01-01VIRGINIA LATOCKI VIRGINIA LATOCKI2013-07-24
5012011-01-01VIRGINIA LATOCKI
5012010-01-01VIRGINIA LATOCKI
5012009-01-01VIRGINIA LATOCKI

Plan Statistics for WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN

401k plan membership statisitcs for WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN

Measure Date Value
2017: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01604
Total number of active participants reported on line 7a of the Form 55002017-01-01585
Number of retired or separated participants receiving benefits2017-01-011
Total of all active and inactive participants2017-01-01586
Total participants2017-01-01586
2016: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01527
Total number of active participants reported on line 7a of the Form 55002016-01-01617
Number of retired or separated participants receiving benefits2016-01-015
Total of all active and inactive participants2016-01-01622
Total participants2016-01-01622
2015: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01480
Total number of active participants reported on line 7a of the Form 55002015-01-01512
Number of retired or separated participants receiving benefits2015-01-0110
Total of all active and inactive participants2015-01-01522
Total participants2015-01-01522
2014: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01387
Total number of active participants reported on line 7a of the Form 55002014-01-01394
Number of retired or separated participants receiving benefits2014-01-019
Total of all active and inactive participants2014-01-01403
Total participants2014-01-01403
2013: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01364
Total number of active participants reported on line 7a of the Form 55002013-01-01360
Number of retired or separated participants receiving benefits2013-01-0110
Total of all active and inactive participants2013-01-01370
Total participants2013-01-01370
2012: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01360
Total number of active participants reported on line 7a of the Form 55002012-01-01352
Number of retired or separated participants receiving benefits2012-01-0112
Total of all active and inactive participants2012-01-01364
Total participants2012-01-01364
2011: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01356
Total number of active participants reported on line 7a of the Form 55002011-01-01350
Number of retired or separated participants receiving benefits2011-01-0110
Total of all active and inactive participants2011-01-01360
Total participants2011-01-01360
2010: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01324
Total number of active participants reported on line 7a of the Form 55002010-01-01350
Number of retired or separated participants receiving benefits2010-01-016
Total of all active and inactive participants2010-01-01356
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01356
2009: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01336
Total number of active participants reported on line 7a of the Form 55002009-01-01303
Number of retired or separated participants receiving benefits2009-01-0120
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01323
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
Total participants2009-01-01324

Form 5500 Responses for WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN

2017: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes
2016: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2015: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2014: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2013: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2012: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2011: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2010: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2009: WESTERN NATIONAL MUTUAL MEDICAL AND DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99275751001
Policy instance 3
Insurance contract or identification number99275751001
Number of Individuals Covered295
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,210
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $32,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,210
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B3QC
Policy instance 2
Insurance contract or identification numberG000B3QC
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $22,929
Total amount of fees paid to insurance companyUSD $10,858
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $382,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees10858
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $22,929
Insurance broker nameMARSH & MCLENNAN AGENCY INC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered1217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,760
Total amount of fees paid to insurance companyUSD $54,850
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $848,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,760
Amount paid for insurance broker fees54850
Additional information about fees paid to insurance brokerBROKER SERVICE FEE AND COLLABORATIVE SOLUTIONS PARTNERS BONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 2
Insurance contract or identification number011178
Number of Individuals Covered512
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $26,762
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 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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $353,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,762
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSIONS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGNECY LLC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered904
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $49,200
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 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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $831,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees49200
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker namePATRICIA KRIHA
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 2
Insurance contract or identification number011178
Number of Individuals Covered394
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,567
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 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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $271,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,567
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSIONS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered884
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $46,013
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 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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $832,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees46013
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker namePATRICIA KRIHA
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 2
Insurance contract or identification number011178
Number of Individuals Covered539
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,472
Total amount of fees paid to insurance companyUSD $0
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 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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $280,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,472
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY LLC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered845
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,938
Total amount of fees paid to insurance companyUSD $38,318
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 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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $696,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,938
Amount paid for insurance broker fees38318
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker namePATRICIA K. KRIHA
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 2
Insurance contract or identification number011178
Number of Individuals Covered530
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $12,767
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $261,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,595
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered817
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,408
Total amount of fees paid to insurance companyUSD $40,345
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $635,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,408
Amount paid for insurance broker fees40345
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker namePATRICIA K. KRIHA
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 2
Insurance contract or identification number011178
Number of Individuals Covered522
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,642
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $251,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 1
Insurance contract or identification number18949
Number of Individuals Covered792
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,695
Total amount of fees paid to insurance companyUSD $41,588
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $605,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number18949
Policy instance 2
Insurance contract or identification number18949
Number of Individuals Covered805
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $17,248
Total amount of fees paid to insurance companyUSD $36,223
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $470,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,248
Amount paid for insurance broker fees36223
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker namePATRICIA KRIHA, RJF AGENCIES, INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number011178
Policy instance 1
Insurance contract or identification number011178
Number of Individuals Covered518
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,119
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $216,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,119
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER SERVICE FEE
Insurance broker organization code?3
Insurance broker nameRJF AGENCIES, INC.

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