JEFFERSON COMMUNITY HEALTH CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN
401k plan membership statisitcs for JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN
| Measure | Date | Value |
|---|
| 2023: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 150 |
| Total of all active and inactive participants | 2023-01-01 | 150 |
| 2022: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 152 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 2 |
| Total of all active and inactive participants | 2022-07-01 | 154 |
| 2021: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 183 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 193 |
| Total of all active and inactive participants | 2021-12-01 | 193 |
| 2020: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 183 |
| Total of all active and inactive participants | 2020-12-01 | 183 |
| 2019: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 186 |
| Total of all active and inactive participants | 2019-12-01 | 186 |
| Total participants | 2019-12-01 | 186 |
| 2018: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 182 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 179 |
| Total of all active and inactive participants | 2018-12-01 | 179 |
| Total participants | 2018-12-01 | 179 |
| 2017: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 182 |
| Total of all active and inactive participants | 2017-12-01 | 182 |
| Total participants | 2017-12-01 | 182 |
| 2016: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 179 |
| Total of all active and inactive participants | 2016-12-01 | 179 |
| Total participants | 2016-12-01 | 179 |
| 2015: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 176 |
| Total of all active and inactive participants | 2015-12-01 | 176 |
| Total participants | 2015-12-01 | 176 |
| 2014: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 175 |
| Total of all active and inactive participants | 2014-12-01 | 175 |
| Total participants | 2014-12-01 | 175 |
| 2013: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 141 |
| Total of all active and inactive participants | 2013-12-01 | 141 |
| Total participants | 2013-12-01 | 141 |
| 2012: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 140 |
| Total of all active and inactive participants | 2012-12-01 | 140 |
| Total participants | 2012-12-01 | 140 |
| 2011: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 139 |
| Total of all active and inactive participants | 2011-12-01 | 139 |
| Total participants | 2011-12-01 | 139 |
| Total participants, beginning-of-year | 2011-09-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 127 |
| Total of all active and inactive participants | 2011-09-01 | 127 |
| Total participants | 2011-09-01 | 127 |
| 2010: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 131 |
| Total of all active and inactive participants | 2010-09-01 | 131 |
| Total participants | 2010-09-01 | 131 |
| 2009: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 130 |
| Total of all active and inactive participants | 2009-09-01 | 130 |
| Total participants | 2009-09-01 | 130 |
| 2023: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2022: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 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 benefit arrangement – Insurance | Yes |
| 2018: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 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 benefit arrangement – Insurance | Yes |
| 2017: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 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 benefit arrangement – Insurance | Yes |
| 2016: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Submission has been amended | No |
| 2016-12-01 | This submission is the final filing | No |
| 2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-12-01 | Plan is a collectively bargained plan | No |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Submission has been amended | No |
| 2014-12-01 | This submission is the final filing | No |
| 2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-12-01 | Plan is a collectively bargained plan | No |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Submission has been amended | No |
| 2013-12-01 | This submission is the final filing | No |
| 2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-12-01 | Plan is a collectively bargained plan | No |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | Submission has been amended | No |
| 2012-12-01 | This submission is the final filing | No |
| 2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-12-01 | Plan is a collectively bargained plan | No |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | Submission has been amended | No |
| 2011-12-01 | This submission is the final filing | No |
| 2011-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-12-01 | Plan is a collectively bargained plan | No |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Submission has been amended | No |
| 2010-09-01 | This submission is the final filing | No |
| 2010-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-09-01 | Plan is a collectively bargained plan | No |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: JEFFERSON COMMUNITY HEALTH CENTER LIFE INSURANCE & LTD PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | No |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144637 |
| Policy instance | 2 |
| Insurance contract or identification number | 144637 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $4,026 | | Total amount of fees paid to insurance company | USD $629 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $50,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-041522 |
| Policy instance | 5 |
| Insurance contract or identification number | 010-041522 | | Number of Individuals Covered | 327 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $10,418 | | Total amount of fees paid to insurance company | USD $705 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 919584 |
| Policy instance | 4 |
| Insurance contract or identification number | 919584 | | 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 $5,056 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $22,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $696 | | Total amount of fees paid to insurance company | USD $109 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 691292 |
| Policy instance | 3 |
| Insurance contract or identification number | 691292 | | Number of Individuals Covered | 22 | | 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 $22 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144637 |
| Policy instance | 2 |
| Insurance contract or identification number | 144637 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $299 | | Total amount of fees paid to insurance company | USD $47 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $299 | | Amount paid for insurance broker fees | 47 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $111 | | Total amount of fees paid to insurance company | USD $17 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111 | | Amount paid for insurance broker fees | 17 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 691292 |
| Policy instance | 3 |
| Insurance contract or identification number | 691292 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $139 | | Total amount of fees paid to insurance company | USD $30 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $139 | | Amount paid for insurance broker fees | 30 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $1,145 | | Total amount of fees paid to insurance company | USD $179 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,145 | | Amount paid for insurance broker fees | 179 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $1,106 | | Total amount of fees paid to insurance company | USD $173 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,106 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 173 | | Additional information about fees paid to insurance broker | ADDITIONIAL COMPENSATION PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $991 | | Total amount of fees paid to insurance company | USD $155 | | 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 | Yes | | 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 $11,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 155 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $1,043 | | Total amount of fees paid to insurance company | USD $163 | | 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 | Yes | | 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 $14,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,043 | | Amount paid for insurance broker fees | 163 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 144636 |
| Policy instance | 1 |
| Insurance contract or identification number | 144636 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $1,040 | | Total amount of fees paid to insurance company | USD $163 | | 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 | Yes | | 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 $11,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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