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NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan NameNANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN
Plan identification number 003

NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NMH has sponsored the creation of one or more 401k plans.

Company Name:NMH
Employer identification number (EIN):510069243
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about NMH

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 398126

More information about NMH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032021-01-01
0032020-01-01

Plan Statistics for NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN

Measure Date Value
2021: NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,591
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-010
Number of participants with account balances2021-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,631
Total number of active participants reported on line 7a of the Form 55002020-01-01987
Number of retired or separated participants receiving benefits2020-01-0133
Number of other retired or separated participants entitled to future benefits2020-01-01571
Total of all active and inactive participants2020-01-011,591
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-011,591
Number of participants with account balances2020-01-011,413
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-01137

Financial Data on NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN

Measure Date Value
2021 : NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-04-01$0
Total transfer of assets from this plan2021-04-01$69,876,478
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-04-01$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-04-01$0
Total income from all sources (including contributions)2021-04-01$2,231,437
Total loss/gain on sale of assets2021-04-01$0
Total of all expenses incurred2021-04-01$5,988,521
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-04-01$5,970,863
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-04-01$0
Value of total assets at end of year2021-04-01$0
Value of total assets at beginning of year2021-04-01$73,633,562
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-04-01$17,658
Total interest from all sources2021-04-01$46,437
Total dividends received (eg from common stock, registered investment company shares)2021-04-01$98,632
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-04-01Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2021-04-01$0
Total dividends received from registered investment company shares (eg mutual funds)2021-04-01$98,632
Was this plan covered by a fidelity bond2021-04-01Yes
Value of fidelity bond cover2021-04-01$10,000,000
If this is an individual account plan, was there a blackout period2021-04-01No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-04-01$0
Were there any nonexempt tranactions with any party-in-interest2021-04-01No
Participant contributions at beginning of year2021-04-01$947,549
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-04-01No
Value of net income/loss2021-04-01$-3,757,084
Value of net assets at end of year (total assets less liabilities)2021-04-01$0
Value of net assets at beginning of year (total assets less liabilities)2021-04-01$73,633,562
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-04-01No
Were any loans by the plan or fixed income obligations due to the plan in default2021-04-01No
Were any leases to which the plan was party in default or uncollectible2021-04-01No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-04-01$62,382,313
Interest on participant loans2021-04-01$10,640
Interest earned on other investments2021-04-01$35,797
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-04-01$9,808,184
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-04-01$2,086,368
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-04-01No
Was there a failure to transmit to the plan any participant contributions2021-04-01No
Has the plan failed to provide any benefit when due under the plan2021-04-01No
Employer contributions (assets) at beginning of year2021-04-01$495,516
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-04-01$5,970,863
Contract administrator fees2021-04-01$17,658
Did the plan have assets held for investment2021-04-01No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-04-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-04-01Yes
Opinion of an independent qualified public accountant for this plan2021-04-01Disclaimer
Accountancy firm name2021-04-01CLIFTONLARSONALLEN LLP
Accountancy firm EIN2021-04-01410746749
2020 : NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Expenses. Interest paid2020-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022020-12-31$0
Total income from all sources (including contributions)2020-12-31$15,092,524
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$6,637,172
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$6,449,569
Expenses. Certain deemed distributions of participant loans2020-12-31$128,917
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$4,201,344
Value of total assets at end of year2020-12-31$73,633,562
Value of total assets at beginning of year2020-12-31$65,178,210
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$58,686
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$209,884
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$1,901,575
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$1,901,575
Assets. Real estate other than employer real property at end of year2020-12-31$0
Assets. Real estate other than employer real property at beginning of year2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$3,210,341
Participant contributions at end of year2020-12-31$947,549
Participant contributions at beginning of year2020-12-31$1,314,105
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Assets. Other investments not covered elsewhere at end of year2020-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$503,591
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Assets. Loans (other than to participants) at end of year2020-12-31$0
Assets. Loans (other than to participants) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Income. Non cash contributions2020-12-31$0
Value of net income/loss2020-12-31$8,455,352
Value of net assets at end of year (total assets less liabilities)2020-12-31$73,633,562
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$65,178,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Assets. partnership/joint venture interests at end of year2020-12-31$0
Assets. partnership/joint venture interests at beginning of year2020-12-31$0
Investment advisory and management fees2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$62,382,313
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$54,196,534
Value of interest in pooled separate accounts at end of year2020-12-31$0
Value of interest in pooled separate accounts at beginning of year2020-12-31$0
Interest on participant loans2020-12-31$54,220
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$155,664
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Value of interest in master investment trust accounts at end of year2020-12-31$0
Value of interest in master investment trust accounts at beginning of year2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$0
Value of interest in common/collective trusts at beginning of year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2020-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$9,808,184
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$9,210,160
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Asset value of US Government securities at end of year2020-12-31$0
Asset value of US Government securities at beginning of year2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$8,779,721
Net investment gain/loss from pooled separate accounts2020-12-31$0
Net investment gain or loss from common/collective trusts2020-12-31$0
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Assets. Invements in employer securities at end of year2020-12-31$0
Assets. Invements in employer securities at beginning of year2020-12-31$0
Assets. Value of employer real property at end of year2020-12-31$0
Assets. Value of employer real property at beginning of year2020-12-31$0
Contributions received in cash from employer2020-12-31$487,412
Employer contributions (assets) at end of year2020-12-31$495,516
Employer contributions (assets) at beginning of year2020-12-31$457,411
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$6,449,569
Asset. Corporate debt instrument preferred debt at end of year2020-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$0
Contract administrator fees2020-12-31$58,686
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$0
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-12-31$0
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2020-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2020-12-31410746749

Form 5500 Responses for NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN

2021: NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: NANTICOKE MEMORIAL HOSPITAL RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number95854-01
Policy instance 1
Insurance contract or identification number95854-01
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number025382
Policy instance 2
Insurance contract or identification number025382
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-04-01
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
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: 65675 )
Policy contract numberGP26145
Policy instance 3
Insurance contract or identification numberGP26145
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-04-01
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HORACE MANN LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 64513 )
Policy contract number07058
Policy instance 4
Insurance contract or identification number07058
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-04-01
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number95854-01
Policy instance 1
Insurance contract or identification number95854-01
Number of Individuals Covered389
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number025382
Policy instance 2
Insurance contract or identification number025382
Number of Individuals Covered18
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
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: 65675 )
Policy contract numberGP26145
Policy instance 3
Insurance contract or identification numberGP26145
Number of Individuals Covered2
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $560
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $560
Insurance broker organization code?4
HORACE MANN LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 64513 )
Policy contract number07058
Policy instance 4
Insurance contract or identification number07058
Number of Individuals Covered2
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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