MID-NEBRASKA INDIVIDUAL SERVICES, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN
401k plan membership statisitcs for MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2023: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-02-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-02-01 | 116 |
| Total of all active and inactive participants | 2023-02-01 | 116 |
| Total participants | 2023-02-01 | 116 |
| 2022: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 119 |
| Total of all active and inactive participants | 2022-02-01 | 119 |
| Total participants | 2022-02-01 | 119 |
| 2021: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 142 |
| Total of all active and inactive participants | 2021-02-01 | 142 |
| Total participants | 2021-02-01 | 142 |
| 2020: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 162 |
| Total of all active and inactive participants | 2020-02-01 | 162 |
| Total participants | 2020-02-01 | 162 |
| 2019: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 170 |
| Total of all active and inactive participants | 2019-02-01 | 170 |
| Total participants | 2019-02-01 | 170 |
| 2017: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 180 |
| Total of all active and inactive participants | 2017-02-01 | 180 |
| Total participants | 2017-02-01 | 180 |
| 2016: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 172 |
| Total of all active and inactive participants | 2016-02-01 | 172 |
| Total participants | 2016-02-01 | 172 |
| 2015: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 180 |
| Total of all active and inactive participants | 2015-02-01 | 180 |
| Total participants | 2015-02-01 | 180 |
| 2014: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 144 |
| Total of all active and inactive participants | 2014-02-01 | 144 |
| Total participants | 2014-02-01 | 144 |
| 2013: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 141 |
| Total of all active and inactive participants | 2013-02-01 | 141 |
| Total participants | 2013-02-01 | 141 |
| 2012: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 139 |
| Total of all active and inactive participants | 2012-02-01 | 139 |
| Total participants | 2012-02-01 | 139 |
| 2011: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 153 |
| Total of all active and inactive participants | 2011-02-01 | 153 |
| Total participants | 2011-02-01 | 153 |
| 2009: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 182 |
| Total of all active and inactive participants | 2009-02-01 | 182 |
| Total participants | 2009-02-01 | 182 |
| 2023: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2023 form 5500 responses |
|---|
| 2023-02-01 | Type of plan entity | Single employer plan |
| 2023-02-01 | Submission has been amended | No |
| 2023-02-01 | This submission is the final filing | No |
| 2023-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-02-01 | Plan is a collectively bargained plan | No |
| 2023-02-01 | Plan funding arrangement – Insurance | Yes |
| 2023-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Submission has been amended | No |
| 2022-02-01 | This submission is the final filing | No |
| 2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-02-01 | Plan is a collectively bargained plan | No |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Submission has been amended | No |
| 2021-02-01 | This submission is the final filing | No |
| 2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-02-01 | Plan is a collectively bargained plan | No |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Submission has been amended | No |
| 2020-02-01 | This submission is the final filing | No |
| 2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-02-01 | Plan is a collectively bargained plan | No |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Submission has been amended | No |
| 2019-02-01 | This submission is the final filing | No |
| 2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-02-01 | Plan is a collectively bargained plan | No |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | Yes |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Submission has been amended | No |
| 2014-02-01 | This submission is the final filing | No |
| 2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-02-01 | Plan is a collectively bargained plan | No |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Submission has been amended | No |
| 2013-02-01 | This submission is the final filing | No |
| 2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-02-01 | Plan is a collectively bargained plan | No |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Submission has been amended | No |
| 2012-02-01 | This submission is the final filing | No |
| 2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-02-01 | Plan is a collectively bargained plan | No |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Submission has been amended | No |
| 2011-02-01 | This submission is the final filing | No |
| 2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-02-01 | Plan is a collectively bargained plan | No |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: MID-NEBRASKA INDIVIDUAL SERVICES INC EMPLOYEE MEDICAL & DENTAL BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Submission has been amended | No |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-02-01 | Plan is a collectively bargained plan | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40631 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40631 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2023-02-01 | | Insurance policy end date | 2024-01-31 | | Total amount of commissions paid to insurance broker | USD $2,199 | | 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 | | Other welfare benefits provided | ORGAN TRANSPLANT | | 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 $21,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010005399 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2023-02-01 | | Insurance policy end date | 2024-01-31 | | Total amount of commissions paid to insurance broker | USD $1,010 | | 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 | | 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 $8,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERLL23101545005 |
| Policy instance | 2 |
| Insurance contract or identification number | ERLL23101545005 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2023-02-01 | | Insurance policy end date | 2024-01-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 | | 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 $578,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 1 |
| Insurance contract or identification number | 86603 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2023-02-01 | | Insurance policy end date | 2024-01-31 | | Total amount of commissions paid to insurance broker | USD $5,691 | | 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 | Yes | | 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 | | 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 $18,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 1 |
| Insurance contract or identification number | 86603 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $1,277 | | 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 | Yes | | 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 | | 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 $14,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010005399 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $1,004 | | 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 | | 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 $8,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERLL21101545004 |
| Policy instance | 3 |
| Insurance contract or identification number | ERLL21101545004 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 | | 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 $469,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40631 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40631 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $2,210 | | 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 | | Other welfare benefits provided | ORGAN TRANSPLANT | | 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 $22,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 4 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 3 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40631 |
| Policy instance | 2 |
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERLL21101545003 |
| Policy instance | 1 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40631 |
| Policy instance | 4 |
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERLL20101545002 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 1 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40631 |
| Policy instance | 2 |
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERLL20101545001 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 4 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 86603 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010005399 |
| Policy instance | 3 |
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-4955 |
| Policy instance | 2 |
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | MDU0051 |
| Policy instance | 1 |
