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USA 800, INC. EMPLOYEE HEALTH & LIFE 401k Plan overview

Plan NameUSA 800, INC. EMPLOYEE HEALTH & LIFE
Plan identification number 501

USA 800, INC. EMPLOYEE HEALTH & LIFE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

USA 800, INC. has sponsored the creation of one or more 401k plans.

Company Name:USA 800, INC.
Employer identification number (EIN):431119494
NAIC Classification:561420

Additional information about USA 800, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1995-01-01
Company Identification Number: 0010831306
Legal Registered Office Address: 100 NE 3RD AVE STE 200

FT LAUDERDALE
United States of America (USA)
33301

More information about USA 800, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USA 800, INC. EMPLOYEE HEALTH & LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-09-01DANIEL QUIGLEY DANIEL QUIGLEY2018-06-15
5012016-09-01DANIEL QUIGLEY DANIEL QUIGLEY2018-05-16
5012015-09-01DAN QUIGLEY DAN QUIGLEY2017-03-29
5012014-11-01DAN QUIGLEY DAN QUIGLEY2016-02-22
5012013-11-01PHIL GROSS PHIL GROSS2015-05-12
5012012-11-01PHIL GROSS
5012011-11-01PHIL GROSS
5012009-11-01PHIL GROSS
5012008-11-01PHIL GROSS
5012007-11-01PHIL GROSS
5012006-11-01PHIL GROSS
5012005-11-01PHIL GROSS
5012004-11-01PHIL GROSS

Plan Statistics for USA 800, INC. EMPLOYEE HEALTH & LIFE

401k plan membership statisitcs for USA 800, INC. EMPLOYEE HEALTH & LIFE

Measure Date Value
2017: USA 800, INC. EMPLOYEE HEALTH & LIFE 2017 401k membership
Total participants, beginning-of-year2017-09-01491
Total number of active participants reported on line 7a of the Form 55002017-09-010
Number of retired or separated participants receiving benefits2017-09-010
Total of all active and inactive participants2017-09-010
2016: USA 800, INC. EMPLOYEE HEALTH & LIFE 2016 401k membership
Total participants, beginning-of-year2016-09-01569
Total number of active participants reported on line 7a of the Form 55002016-09-01513
Number of retired or separated participants receiving benefits2016-09-011
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01514
2015: USA 800, INC. EMPLOYEE HEALTH & LIFE 2015 401k membership
Total participants, beginning-of-year2015-09-01228
Total number of active participants reported on line 7a of the Form 55002015-09-01354
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01354
2014: USA 800, INC. EMPLOYEE HEALTH & LIFE 2014 401k membership
Total participants, beginning-of-year2014-11-01275
Total number of active participants reported on line 7a of the Form 55002014-11-01384
Number of retired or separated participants receiving benefits2014-11-012
Total of all active and inactive participants2014-11-01386
2013: USA 800, INC. EMPLOYEE HEALTH & LIFE 2013 401k membership
Total participants, beginning-of-year2013-11-01348
Total number of active participants reported on line 7a of the Form 55002013-11-01283
Total of all active and inactive participants2013-11-01283
2012: USA 800, INC. EMPLOYEE HEALTH & LIFE 2012 401k membership
Total participants, beginning-of-year2012-11-01356
Total number of active participants reported on line 7a of the Form 55002012-11-01356
Total of all active and inactive participants2012-11-01356
2011: USA 800, INC. EMPLOYEE HEALTH & LIFE 2011 401k membership
Total participants, beginning-of-year2011-11-01477
Total number of active participants reported on line 7a of the Form 55002011-11-01355
Number of retired or separated participants receiving benefits2011-11-011
Number of other retired or separated participants entitled to future benefits2011-11-010
Total of all active and inactive participants2011-11-01356
2009: USA 800, INC. EMPLOYEE HEALTH & LIFE 2009 401k membership
Total participants, beginning-of-year2009-11-01382
Total number of active participants reported on line 7a of the Form 55002009-11-01426
Number of retired or separated participants receiving benefits2009-11-012
Total of all active and inactive participants2009-11-01428
Total participants2009-11-010
2008: USA 800, INC. EMPLOYEE HEALTH & LIFE 2008 401k membership
Total participants, beginning-of-year2008-11-01366
Total number of active participants reported on line 7a of the Form 55002008-11-01359
Number of retired or separated participants receiving benefits2008-11-010
Number of other retired or separated participants entitled to future benefits2008-11-010
Total of all active and inactive participants2008-11-01359
Total participants2008-11-01359
2007: USA 800, INC. EMPLOYEE HEALTH & LIFE 2007 401k membership
Total participants, beginning-of-year2007-11-01241
Total number of active participants reported on line 7a of the Form 55002007-11-01366
Number of retired or separated participants receiving benefits2007-11-010
Number of other retired or separated participants entitled to future benefits2007-11-010
Total of all active and inactive participants2007-11-01366
Total participants2007-11-01366
2006: USA 800, INC. EMPLOYEE HEALTH & LIFE 2006 401k membership
Total participants, beginning-of-year2006-11-01185
Total number of active participants reported on line 7a of the Form 55002006-11-01241
Number of retired or separated participants receiving benefits2006-11-010
Number of other retired or separated participants entitled to future benefits2006-11-010
Total of all active and inactive participants2006-11-01241
Total participants2006-11-01241
2005: USA 800, INC. EMPLOYEE HEALTH & LIFE 2005 401k membership
Total participants, beginning-of-year2005-11-01142
Total number of active participants reported on line 7a of the Form 55002005-11-01185
Number of retired or separated participants receiving benefits2005-11-010
Number of other retired or separated participants entitled to future benefits2005-11-010
Total of all active and inactive participants2005-11-01185
Total participants2005-11-01185
2004: USA 800, INC. EMPLOYEE HEALTH & LIFE 2004 401k membership
Total participants, beginning-of-year2004-11-01115
Total number of active participants reported on line 7a of the Form 55002004-11-01142
Number of retired or separated participants receiving benefits2004-11-010
Number of other retired or separated participants entitled to future benefits2004-11-010
Total of all active and inactive participants2004-11-01142
Total participants2004-11-01142

Form 5500 Responses for USA 800, INC. EMPLOYEE HEALTH & LIFE

2017: USA 800, INC. EMPLOYEE HEALTH & LIFE 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingYes
2017-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: USA 800, INC. EMPLOYEE HEALTH & LIFE 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: USA 800, INC. EMPLOYEE HEALTH & LIFE 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: USA 800, INC. EMPLOYEE HEALTH & LIFE 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: USA 800, INC. EMPLOYEE HEALTH & LIFE 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes
2012: USA 800, INC. EMPLOYEE HEALTH & LIFE 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – InsuranceYes
2011: USA 800, INC. EMPLOYEE HEALTH & LIFE 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – InsuranceYes
2009: USA 800, INC. EMPLOYEE HEALTH & LIFE 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – InsuranceYes
2008: USA 800, INC. EMPLOYEE HEALTH & LIFE 2008 form 5500 responses
2008-11-01Type of plan entitySingle employer plan
2008-11-01Submission has been amendedNo
2008-11-01This submission is the final filingNo
2008-11-01This return/report is a short plan year return/report (less than 12 months)No
2008-11-01Plan is a collectively bargained planNo
2008-11-01Plan funding arrangement – InsuranceYes
2008-11-01Plan benefit arrangement – InsuranceYes
2007: USA 800, INC. EMPLOYEE HEALTH & LIFE 2007 form 5500 responses
2007-11-01Type of plan entitySingle employer plan
2007-11-01Submission has been amendedNo
2007-11-01This submission is the final filingNo
2007-11-01This return/report is a short plan year return/report (less than 12 months)No
2007-11-01Plan is a collectively bargained planNo
2007-11-01Plan funding arrangement – InsuranceYes
2007-11-01Plan benefit arrangement – InsuranceYes
2006: USA 800, INC. EMPLOYEE HEALTH & LIFE 2006 form 5500 responses
2006-11-01Type of plan entitySingle employer plan
2006-11-01Submission has been amendedNo
2006-11-01This submission is the final filingNo
2006-11-01This return/report is a short plan year return/report (less than 12 months)No
2006-11-01Plan is a collectively bargained planNo
2006-11-01Plan funding arrangement – InsuranceYes
2006-11-01Plan benefit arrangement – InsuranceYes
2005: USA 800, INC. EMPLOYEE HEALTH & LIFE 2005 form 5500 responses
2005-11-01Type of plan entitySingle employer plan
2005-11-01Submission has been amendedNo
2005-11-01This submission is the final filingNo
2005-11-01This return/report is a short plan year return/report (less than 12 months)No
2005-11-01Plan is a collectively bargained planNo
2005-11-01Plan funding arrangement – InsuranceYes
2005-11-01Plan benefit arrangement – InsuranceYes
2004: USA 800, INC. EMPLOYEE HEALTH & LIFE 2004 form 5500 responses
2004-11-01Type of plan entitySingle employer plan
2004-11-01First time form 5500 has been submittedYes
2004-11-01Submission has been amendedNo
2004-11-01This submission is the final filingNo
2004-11-01This return/report is a short plan year return/report (less than 12 months)No
2004-11-01Plan is a collectively bargained planNo
2004-11-01Plan funding arrangement – InsuranceYes
2004-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberE57
Policy instance 2
Insurance contract or identification numberE57
Number of Individuals Covered407
Insurance policy start date2017-09-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5481214
Policy instance 1
Insurance contract or identification number5481214
Number of Individuals Covered1429
Insurance policy start date2017-09-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $22,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number37492000
Policy instance 2
Insurance contract or identification number37492000
Number of Individuals Covered354
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $63,600
Total amount of fees paid to insurance companyUSD $28,025
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,600
Amount paid for insurance broker fees28025
Additional information about fees paid to insurance brokerPROVISION OF ADMINISTRATIVE SERVICES TO BCBSKC
Insurance broker organization code?3
Insurance broker nameROBERT MILLER INSURANCE AGENCY INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302426
Policy instance 1
Insurance contract or identification number302426
Number of Individuals Covered1483
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $3,649
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,649
Insurance broker organization code?3
Insurance broker nameROBERT MILLER INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302426
Policy instance 1
Insurance contract or identification number302426
Number of Individuals Covered384
Insurance policy start date2014-11-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameROBERT MILLER INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0712970
Policy instance 2
Insurance contract or identification number0712970
Number of Individuals Covered201
Insurance policy start date2014-11-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $46,226
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,154,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees46226
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameROBERT E MILLER INSURANCE AGENCY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302426
Policy instance 1
Insurance contract or identification number302426
Number of Individuals Covered283
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $2,380
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $23,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameROBERT MILLER INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number712970
Policy instance 2
Insurance contract or identification number712970
Number of Individuals Covered252
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $55
Total amount of fees paid to insurance companyUSD $44,668
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,011,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55
Amount paid for insurance broker fees41788
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameROBERT E MILLER INSURANCE AGENCY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number712970
Policy instance 2
Insurance contract or identification number712970
Number of Individuals Covered126
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $33,289
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 BenefitYes
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
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 $749,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,247
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameROBERT E. MILLER INSURANCE COMPANY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302428
Policy instance 1
Insurance contract or identification number302428
Number of Individuals Covered356
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $2,393
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 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 $24,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,393
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBERT MILLER INSURANCE
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract number51253
Policy instance 3
Insurance contract or identification number51253
Number of Individuals Covered63
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $3,943
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS
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 $14,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,563
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBERT E. MILLER INSURANCE AGENCY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number801752
Policy instance 4
Insurance contract or identification number801752
Number of Individuals Covered40
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $11,187
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 BenefitYes
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
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 $112,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,187
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameROBERT E. MILLER INSURANCE AGENCY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302426
Policy instance 1
Insurance contract or identification number302426
Number of Individuals Covered356
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $2,441
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0712970
Policy instance 2
Insurance contract or identification number0712970
Number of Individuals Covered252
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $35,884
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $897,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number801752
Policy instance 3
Insurance contract or identification number801752
Number of Individuals Covered34
Insurance policy start date2011-11-01
Insurance policy end date2012-10-30
Total amount of commissions paid to insurance brokerUSD $8,848
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract number51253
Policy instance 4
Insurance contract or identification number51253
Number of Individuals Covered66
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $1,600
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $5,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0712970
Policy instance 1
Insurance contract or identification number0712970
Number of Individuals Covered252
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $43,418
Total amount of fees paid to insurance companyUSD $13,163
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,085,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number302426
Policy instance 3
Insurance contract or identification number302426
Number of Individuals Covered563
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $2,522
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $27,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number801752
Policy instance 2
Insurance contract or identification number801752
Number of Individuals Covered58
Insurance policy start date2011-01-01
Insurance policy end date2011-10-30
Total amount of commissions paid to insurance brokerUSD $14,199
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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