USA SPARES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501)
| Measure | Date | Value |
|---|
| 2023 : USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-12-31 | $19,749 |
| Total plan liabilities at beginning of year | 2023-12-31 | $35,909 |
| Total income from all sources | 2023-12-31 | $470,991 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $557,709 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $255,232 |
| Total plan assets at end of year | 2023-12-31 | $181,837 |
| Total plan assets at beginning of year | 2023-12-31 | $284,715 |
| Value of fidelity bond covering the plan | 2023-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2023-12-31 | $58,510 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $194,901 |
| Contributions received from other sources (not participants or employers) | 2023-12-31 | $0 |
| Other income received | 2023-12-31 | $4,985 |
| Net income (gross income less expenses) | 2023-12-31 | $-86,718 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $162,088 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $248,806 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $407,496 |
| Value of corrective distributions | 2023-12-31 | $105,116 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $2,460 |
| 2022 : USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $35,909 |
| Total plan liabilities at beginning of year | 2022-12-31 | $15,615 |
| Total income from all sources | 2022-12-31 | $475,910 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $417,335 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $154,901 |
| Total plan assets at end of year | 2022-12-31 | $284,715 |
| Total plan assets at beginning of year | 2022-12-31 | $205,846 |
| Value of fidelity bond covering the plan | 2022-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $122,401 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $188,197 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $707 |
| Net income (gross income less expenses) | 2022-12-31 | $58,575 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $248,806 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $190,231 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $352,802 |
| Value of corrective distributions | 2022-12-31 | $70,889 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $3,348 |
| 2021 : USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $15,615 |
| Total plan liabilities at beginning of year | 2021-12-31 | $19,578 |
| Total income from all sources | 2021-12-31 | $42,960 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $18,564 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $-1,070 |
| Total plan assets at end of year | 2021-12-31 | $205,846 |
| Total plan assets at beginning of year | 2021-12-31 | $185,413 |
| Value of fidelity bond covering the plan | 2021-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $12,210 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $15,312 |
| Other income received | 2021-12-31 | $42 |
| Net income (gross income less expenses) | 2021-12-31 | $24,396 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $190,231 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $165,835 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $30,708 |
| Value of corrective distributions | 2021-12-31 | $4,322 |
| Total plan liabilities at end of year | 2021-11-30 | $19,578 |
| Total plan liabilities at beginning of year | 2021-11-30 | $30,771 |
| Total income from all sources | 2021-11-30 | $498,466 |
| Expenses. Total of all expenses incurred | 2021-11-30 | $345,603 |
| Benefits paid (including direct rollovers) | 2021-11-30 | $126,155 |
| Total plan assets at end of year | 2021-11-30 | $185,413 |
| Total plan assets at beginning of year | 2021-11-30 | $43,743 |
| Value of fidelity bond covering the plan | 2021-11-30 | $100,000 |
| Total contributions received or receivable from participants | 2021-11-30 | $134,823 |
| Expenses. Other expenses not covered elsewhere | 2021-11-30 | $182,474 |
| Contributions received from other sources (not participants or employers) | 2021-11-30 | $4,313 |
| Other income received | 2021-11-30 | $429 |
| Net income (gross income less expenses) | 2021-11-30 | $152,863 |
| Net plan assets at end of year (total assets less liabilities) | 2021-11-30 | $165,835 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-11-30 | $12,972 |
| Total contributions received or receivable from employer(s) | 2021-11-30 | $358,901 |
| Value of corrective distributions | 2021-11-30 | $25,934 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-11-30 | $11,040 |
| 2020 : USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-11-30 | $30,771 |
| Total plan liabilities at beginning of year | 2020-11-30 | $51,204 |
| Total income from all sources | 2020-11-30 | $469,736 |
| Expenses. Total of all expenses incurred | 2020-11-30 | $414,235 |
| Benefits paid (including direct rollovers) | 2020-11-30 | $242,157 |
| Total plan assets at end of year | 2020-11-30 | $43,743 |
| Total plan assets at beginning of year | 2020-11-30 | $8,675 |
| Value of fidelity bond covering the plan | 2020-11-30 | $100,000 |
| Total contributions received or receivable from participants | 2020-11-30 | $132,849 |
| Expenses. Other expenses not covered elsewhere | 2020-11-30 | $161,456 |
| Contributions received from other sources (not participants or employers) | 2020-11-30 | $0 |
| Other income received | 2020-11-30 | $116 |
| Net income (gross income less expenses) | 2020-11-30 | $55,501 |
| Net plan assets at end of year (total assets less liabilities) | 2020-11-30 | $12,972 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-11-30 | $-42,529 |
| Total contributions received or receivable from employer(s) | 2020-11-30 | $336,771 |
| Value of corrective distributions | 2020-11-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-11-30 | $10,622 |
| 2019 : USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-11-30 | $51,204 |
| Total plan liabilities at beginning of year | 2019-11-30 | $23,050 |
| Total income from all sources | 2019-11-30 | $391,227 |
| Expenses. Total of all expenses incurred | 2019-11-30 | $426,046 |
| Benefits paid (including direct rollovers) | 2019-11-30 | $269,245 |
| Total plan assets at end of year | 2019-11-30 | $8,675 |
| Total plan assets at beginning of year | 2019-11-30 | $15,340 |
| Value of fidelity bond covering the plan | 2019-11-30 | $100,000 |
| Total contributions received or receivable from participants | 2019-11-30 | $118,152 |
| Expenses. Other expenses not covered elsewhere | 2019-11-30 | $140,465 |
| Contributions received from other sources (not participants or employers) | 2019-11-30 | $2,221 |
| Other income received | 2019-11-30 | $57 |
| Net income (gross income less expenses) | 2019-11-30 | $-34,819 |
| Net plan assets at end of year (total assets less liabilities) | 2019-11-30 | $-42,529 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-11-30 | $-7,710 |
| Total contributions received or receivable from employer(s) | 2019-11-30 | $270,797 |
| Value of corrective distributions | 2019-11-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-11-30 | $16,336 |
| 2023: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Submission has been amended | No |
| 2021-12-01 | This submission is the final filing | No |
| 2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-12-01 | Plan is a collectively bargained plan | No |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – Trust | Yes |
| 2021-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement - Trust | Yes |
| 2021-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Submission has been amended | No |
| 2020-12-01 | This submission is the final filing | No |
| 2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-12-01 | Plan is a collectively bargained plan | No |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – Trust | Yes |
| 2020-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement - Trust | Yes |
| 2020-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Submission has been amended | No |
| 2019-12-01 | This submission is the final filing | No |
| 2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-12-01 | Plan is a collectively bargained plan | No |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – Trust | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement - Trust | Yes |
| 2018: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Submission has been amended | No |
| 2018-12-01 | This submission is the final filing | No |
| 2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-12-01 | Plan is a collectively bargained plan | No |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan funding arrangement – Trust | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement - Trust | Yes |
| 2017: USA SPARES, INC. EMPLOYEE BENEFIT PLAN (501) 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | First time form 5500 has been submitted | Yes |
| 2017-12-01 | Submission has been amended | No |
| 2017-12-01 | This submission is the final filing | No |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-12-01 | Plan is a collectively bargained plan | No |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan funding arrangement – Trust | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement - Trust | Yes |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 588 |
| Policy instance | 4 |
| Insurance contract or identification number | 588 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $316 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $2,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| Insurance contract or identification number | 8528 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $143 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $2,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| Insurance contract or identification number | 1228 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $1,796 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $17,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-203560 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-203560 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $172,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500318 |
| Policy instance | 1 |
| Insurance contract or identification number | 30500318 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $160,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| Insurance contract or identification number | 1228 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,093 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $20,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| Insurance contract or identification number | 8528 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $152 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 588 |
| Policy instance | 4 |
| Insurance contract or identification number | 588 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $376 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $2,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 588 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500318 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 588 |
| Policy instance | 4 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500318 |
| Policy instance | 1 |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 588 |
| Policy instance | 4 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500318 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 4 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 8528 |
| Policy instance | 3 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 1228 |
| Policy instance | 2 |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) |
| Policy contract number | 65129 |
| Policy instance | 4 |
