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HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 401k Plan overview

Plan NameHANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN
Plan identification number 503

HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

HANDICAP VILLAGE DBA ONE VISION has sponsored the creation of one or more 401k plans.

Company Name:HANDICAP VILLAGE DBA ONE VISION
Employer identification number (EIN):420953968
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about HANDICAP VILLAGE DBA ONE VISION

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1966-11-21
Company Identification Number: 058407
Legal Registered Office Address: 1200 N 9TH STREET W

CLEAR LAKE
United States of America (USA)
50428

More information about HANDICAP VILLAGE DBA ONE VISION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-01-01MARIO VAN DIJK2024-10-01 MARIO VAN DIJK2024-10-01
5032022-01-01MARIO VAN DIJK2023-07-28 MARIO VAN DIJK2023-07-28
5032021-01-01MARIO VAN DIJK2022-06-24 MARIO VAN DJIK2022-06-24
5032020-01-01MARIO VAN DIJK2021-07-23 MARIO VAN DIJK2021-07-23
5032019-01-01MARK DODD2020-10-05 MARK DODD2020-10-05
5032018-01-01MARK DODD2019-09-30 MARK DODD2019-09-30
5032017-01-01
5032016-01-01
5032015-01-01
5032014-01-01GREG BRAUN GREG BRAUN2015-10-14
5032013-01-01GREG BRAUN GREG BRAUN2014-07-29
5032012-01-01GREG BRAUN
5032011-01-01GREG BRAUN

Plan Statistics for HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN

401k plan membership statisitcs for HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN

Measure Date Value
2023: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01263
Total number of active participants reported on line 7a of the Form 55002023-01-01245
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01245
2022: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01319
Total number of active participants reported on line 7a of the Form 55002022-01-01258
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 participants2022-01-01258
2021: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01387
Total number of active participants reported on line 7a of the Form 55002021-01-01362
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 participants2021-01-01362
2020: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01466
Total number of active participants reported on line 7a of the Form 55002020-01-01388
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 participants2020-01-01388
2019: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01430
Total number of active participants reported on line 7a of the Form 55002019-01-01394
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01394
2018: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01548
Total number of active participants reported on line 7a of the Form 55002018-01-01445
Total of all active and inactive participants2018-01-01445
2017: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01536
Total number of active participants reported on line 7a of the Form 55002017-01-01553
Number of retired or separated participants receiving benefits2017-01-010
Total of all active and inactive participants2017-01-01553
2016: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01531
Total number of active participants reported on line 7a of the Form 55002016-01-01511
Number of retired or separated participants receiving benefits2016-01-011
Total of all active and inactive participants2016-01-01512
2015: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01493
Total number of active participants reported on line 7a of the Form 55002015-01-01504
Total of all active and inactive participants2015-01-01504
2014: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01740
Total number of active participants reported on line 7a of the Form 55002014-01-01717
Total of all active and inactive participants2014-01-01717
Total participants2014-01-01717
2013: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01706
Total number of active participants reported on line 7a of the Form 55002013-01-01740
Total of all active and inactive participants2013-01-01740
Total participants2013-01-01740
2012: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01463
Total number of active participants reported on line 7a of the Form 55002012-01-01706
Total of all active and inactive participants2012-01-01706
Total participants2012-01-01706
2011: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0191
Total number of active participants reported on line 7a of the Form 55002011-01-01463
Total of all active and inactive participants2011-01-01463
Total participants2011-01-01463

Form 5500 Responses for HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN

2023: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE 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: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE 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: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE 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: HANDICAP VILLAGE GROUP TERM LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 123813
Policy instance 3
Insurance contract or identification numberLTD 123813
Number of Individuals Covered8
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $258
Total amount of fees paid to insurance companyUSD $570
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 208322
Policy instance 2
Insurance contract or identification numberVAR 208322
Number of Individuals Covered179
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $87
Total amount of fees paid to insurance companyUSD $201
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159961
Policy instance 1
Insurance contract or identification numberGL 159961
Number of Individuals Covered263
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,880
Total amount of fees paid to insurance companyUSD $4,308
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $26,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 208322
Policy instance 2
Insurance contract or identification numberVAR 208322
Number of Individuals Covered186
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $114
Total amount of fees paid to insurance companyUSD $244
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $114
Amount paid for insurance broker fees244
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159961
Policy instance 1
Insurance contract or identification numberGL 159961
Number of Individuals Covered323
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,319
Total amount of fees paid to insurance companyUSD $4,945
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $32,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,319
Amount paid for insurance broker fees4945
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?4
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 208322
Policy instance 2
Insurance contract or identification numberVAR 208322
Number of Individuals Covered137
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $98
Total amount of fees paid to insurance companyUSD $211
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Amount paid for insurance broker fees211
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159961
Policy instance 1
Insurance contract or identification numberGL 159961
Number of Individuals Covered362
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,935
Total amount of fees paid to insurance companyUSD $4,472
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $26,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,935
Amount paid for insurance broker fees4472
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 208322
Policy instance 2
Insurance contract or identification numberVAR 208322
Number of Individuals Covered166
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $87
Total amount of fees paid to insurance companyUSD $188
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $87
Amount paid for insurance broker fees154
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159961
Policy instance 1
Insurance contract or identification numberGL 159961
Number of Individuals Covered367
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,477
Total amount of fees paid to insurance companyUSD $5,138
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,477
Amount paid for insurance broker fees4403
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 208322
Policy instance 2
Insurance contract or identification numberVAR 208322
Number of Individuals Covered197
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $82
Total amount of fees paid to insurance companyUSD $146
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82
Amount paid for insurance broker fees146
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 159961
Policy instance 1
Insurance contract or identification numberGL 159961
Number of Individuals Covered424
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,764
Total amount of fees paid to insurance companyUSD $3,137
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $24,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,764
Amount paid for insurance broker fees3137
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered599
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,041
Total amount of fees paid to insurance companyUSD $106
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $49,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,041
Amount paid for insurance broker fees106
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered711
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,907
Total amount of fees paid to insurance companyUSD $722
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,907
Amount paid for insurance broker fees722
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATION INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered664
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,473
Total amount of fees paid to insurance companyUSD $737
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,473
Amount paid for insurance broker fees737
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATION INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered717
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,946
Total amount of fees paid to insurance companyUSD $751
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $50,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,946
Amount paid for insurance broker fees751
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameHOLMES MURPHY & ASSOCIATION INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered740
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,590
Total amount of fees paid to insurance companyUSD $1,132
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 BenefitYes
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 $127,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,590
Amount paid for insurance broker fees1132
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05987516
Policy instance 1
Insurance contract or identification numberKM05987516
Number of Individuals Covered706
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,283
Total amount of fees paid to insurance companyUSD $2,962
Commission paid to Insurance BrokerUSD $10,245
Insurance broker nameHOLMES MURPHY & ASSOC INC
EMC NATIONAL LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 62928 )
Policy contract numberGL0823
Policy instance 1
Insurance contract or identification numberGL0823
Number of Individuals Covered463
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,314
Total amount of fees paid to insurance companyUSD $3,314
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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