MISSOURI STATE TROOPERS ASSOCIATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 634 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 381 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 240 |
| Total of all active and inactive participants | 2022-05-01 | 621 |
| Total participants | 2022-05-01 | 621 |
| 2021: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 634 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 379 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 255 |
| Total of all active and inactive participants | 2021-05-01 | 634 |
| Total participants | 2021-05-01 | 634 |
| 2020: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 583 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 364 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 219 |
| Total of all active and inactive participants | 2020-05-01 | 583 |
| Total participants | 2020-05-01 | 583 |
| 2019: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 560 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 334 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 226 |
| Total of all active and inactive participants | 2019-05-01 | 560 |
| Total participants | 2019-05-01 | 560 |
| 2018: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 460 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 140 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 305 |
| Total of all active and inactive participants | 2018-05-01 | 445 |
| Total participants | 2018-05-01 | 445 |
| 2017: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 526 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 187 |
| Number of retired or separated participants receiving benefits | 2017-05-01 | 337 |
| Total of all active and inactive participants | 2017-05-01 | 524 |
| Total participants | 2017-05-01 | 524 |
| 2016: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 60 |
| Number of retired or separated participants receiving benefits | 2016-05-01 | 163 |
| Total of all active and inactive participants | 2016-05-01 | 223 |
| 2015: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 138 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 159 |
| Total of all active and inactive participants | 2015-05-01 | 297 |
| 2014: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 350 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 72 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 92 |
| Total of all active and inactive participants | 2014-05-01 | 164 |
| Total participants | 2014-05-01 | 164 |
| 2013: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 198 |
| Number of retired or separated participants receiving benefits | 2013-05-01 | 152 |
| Total of all active and inactive participants | 2013-05-01 | 350 |
| 2012: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 140 |
| Number of retired or separated participants receiving benefits | 2012-05-01 | 150 |
| Total of all active and inactive participants | 2012-05-01 | 290 |
| 2011: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 142 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 148 |
| Total of all active and inactive participants | 2011-05-01 | 290 |
| 2009: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 313 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 159 |
| Number of retired or separated participants receiving benefits | 2009-05-01 | 171 |
| Total of all active and inactive participants | 2009-05-01 | 330 |
| 2022: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: MO STATE TROOPERS ASSOC WELFARE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 22010041 |
| Policy instance | 2 |
| Insurance contract or identification number | 22010041 | | Number of Individuals Covered | 762 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $3,312 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,312 |
|
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
| Policy contract number | 01201140 |
| Policy instance | 1 |
| Insurance contract or identification number | 01201140 | | Number of Individuals Covered | 1479 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $22,701 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $379,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,701 |
|
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
| Policy contract number | 01201140 |
| Policy instance | 2 |
| Insurance contract or identification number | 01201140 | | Number of Individuals Covered | 1427 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $19,058 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $344,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,058 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 22010041 |
| Policy instance | 3 |
| Insurance contract or identification number | 22010041 | | Number of Individuals Covered | 727 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $1,566 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,566 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 08104275 |
| Policy instance | 1 |
| Insurance contract or identification number | 08104275 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,875 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,875 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | ICA3 |
| Policy instance | 1 |
| Insurance contract or identification number | ICA3 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $312 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $312 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 08104275 |
| Policy instance | 2 |
| Insurance contract or identification number | 08104275 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $6,724 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,614 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,724 |
|
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
| Policy contract number | 01201140 |
| Policy instance | 3 |
| Insurance contract or identification number | 01201140 | | Number of Individuals Covered | 1283 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $15,511 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $315,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,511 |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106825 |
| Policy instance | 1 |
| Insurance contract or identification number | K106825 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106821 |
| Policy instance | 2 |
| Insurance contract or identification number | K106821 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $562 | | 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 number | ICA3 |
| Policy instance | 4 |
| Insurance contract or identification number | ICA3 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $329 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $329 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 08104275 |
| Policy instance | 5 |
| Insurance contract or identification number | 08104275 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $6,434 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,371 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,434 |
|
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
| Policy contract number | 01201140 |
| Policy instance | 6 |
| Insurance contract or identification number | 01201140 | | Number of Individuals Covered | 1184 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $3,695 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,695 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469908 |
| Policy instance | 3 |
| Insurance contract or identification number | TS05469908 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,492 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,492 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 08104275 |
| Policy instance | 5 |
| Insurance contract or identification number | 08104275 | | Number of Individuals Covered | 272 | | Total amount of commissions paid to insurance broker | USD $6,432 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,432 |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106821 |
| Policy instance | 2 |
| Insurance contract or identification number | K106821 | | Number of Individuals Covered | 3 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469908 |
| Policy instance | 3 |
| Insurance contract or identification number | TS05469908 | | Number of Individuals Covered | 378 | | Total amount of commissions paid to insurance broker | USD $2,260 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,260 |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106825 |
| Policy instance | 1 |
| Insurance contract or identification number | K106825 | | Number of Individuals Covered | 41 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,487 | | 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 number | ICA3 |
| Policy instance | 4 |
| Insurance contract or identification number | ICA3 | | Number of Individuals Covered | 29 | | Total amount of commissions paid to insurance broker | USD $383 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $383 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | ICA3 |
| Policy instance | 4 |
| Insurance contract or identification number | ICA3 | | Number of Individuals Covered | 33 | | Total amount of commissions paid to insurance broker | USD $437 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106825 |
| Policy instance | 1 |
| Insurance contract or identification number | K106825 | | Number of Individuals Covered | 46 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469908 |
| Policy instance | 3 |
| Insurance contract or identification number | TS05469908 | | Number of Individuals Covered | 482 | | Total amount of commissions paid to insurance broker | USD $2,518 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 08104275 |
| Policy instance | 5 |
| Insurance contract or identification number | 08104275 | | Number of Individuals Covered | 277 | | Total amount of commissions paid to insurance broker | USD $6,669 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST CONTINENTAL LIFE AND ACCIDENT INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 64696 ) |
| Policy contract number | K106821 |
| Policy instance | 2 |
| Insurance contract or identification number | K106821 | | Number of Individuals Covered | 3 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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