BW HEALTH GROUP, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2024 : BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2024 401k financial data |
|---|
| Total plan liabilities at end of year | 2024-06-01 | $144,057 |
| Total plan liabilities at beginning of year | 2024-06-01 | $153,836 |
| Total income from all sources | 2024-06-01 | $71,398 |
| Expenses. Total of all expenses incurred | 2024-06-01 | $113,762 |
| Benefits paid (including direct rollovers) | 2024-06-01 | $89,258 |
| Total plan assets at end of year | 2024-06-01 | $201,465 |
| Total plan assets at beginning of year | 2024-06-01 | $253,608 |
| Value of fidelity bond covering the plan | 2024-06-01 | $33,000 |
| Total contributions received or receivable from participants | 2024-06-01 | $28,262 |
| Expenses. Other expenses not covered elsewhere | 2024-06-01 | $22,661 |
| Contributions received from other sources (not participants or employers) | 2024-06-01 | $5,514 |
| Other income received | 2024-06-01 | $493 |
| Net income (gross income less expenses) | 2024-06-01 | $-42,364 |
| Net plan assets at end of year (total assets less liabilities) | 2024-06-01 | $57,408 |
| Net plan assets at beginning of year (total assets less liabilities) | 2024-06-01 | $99,772 |
| Total contributions received or receivable from employer(s) | 2024-06-01 | $37,129 |
| Value of corrective distributions | 2024-06-01 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2024-06-01 | $1,843 |
| Total plan liabilities at end of year | 2024-05-31 | $153,836 |
| Total plan liabilities at beginning of year | 2024-05-31 | $139,572 |
| Total income from all sources | 2024-05-31 | $809,665 |
| Expenses. Total of all expenses incurred | 2024-05-31 | $771,177 |
| Benefits paid (including direct rollovers) | 2024-05-31 | $493,592 |
| Total plan assets at end of year | 2024-05-31 | $253,608 |
| Total plan assets at beginning of year | 2024-05-31 | $200,856 |
| Value of fidelity bond covering the plan | 2024-05-31 | $33,000 |
| Total contributions received or receivable from participants | 2024-05-31 | $315,777 |
| Expenses. Other expenses not covered elsewhere | 2024-05-31 | $256,727 |
| Contributions received from other sources (not participants or employers) | 2024-05-31 | $7,895 |
| Other income received | 2024-05-31 | $4,642 |
| Net income (gross income less expenses) | 2024-05-31 | $38,488 |
| Net plan assets at end of year (total assets less liabilities) | 2024-05-31 | $99,772 |
| Net plan assets at beginning of year (total assets less liabilities) | 2024-05-31 | $61,284 |
| Total contributions received or receivable from employer(s) | 2024-05-31 | $481,351 |
| Value of corrective distributions | 2024-05-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2024-05-31 | $20,858 |
| 2023 : BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-05-31 | $139,572 |
| Total plan liabilities at beginning of year | 2023-05-31 | $13,837 |
| Total income from all sources | 2023-05-31 | $451,185 |
| Expenses. Total of all expenses incurred | 2023-05-31 | $482,442 |
| Benefits paid (including direct rollovers) | 2023-05-31 | $317,609 |
| Total plan assets at end of year | 2023-05-31 | $200,856 |
| Total plan assets at beginning of year | 2023-05-31 | $106,378 |
| Value of fidelity bond covering the plan | 2023-05-31 | $33,000 |
| Total contributions received or receivable from participants | 2023-05-31 | $160,778 |
| Expenses. Other expenses not covered elsewhere | 2023-05-31 | $144,246 |
| Contributions received from other sources (not participants or employers) | 2023-05-31 | $0 |
| Other income received | 2023-05-31 | $171 |
| Net income (gross income less expenses) | 2023-05-31 | $-31,257 |
| Net plan assets at end of year (total assets less liabilities) | 2023-05-31 | $61,284 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-05-31 | $92,541 |
| Total contributions received or receivable from employer(s) | 2023-05-31 | $290,236 |
| Value of corrective distributions | 2023-05-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-05-31 | $20,587 |
| 2022 : BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-05-31 | $13,837 |
| Total plan liabilities at beginning of year | 2022-05-31 | $20,931 |
| Total income from all sources | 2022-05-31 | $336,721 |
| Expenses. Total of all expenses incurred | 2022-05-31 | $412,933 |
| Benefits paid (including direct rollovers) | 2022-05-31 | $230,741 |
| Total plan assets at end of year | 2022-05-31 | $106,378 |
| Total plan assets at beginning of year | 2022-05-31 | $189,684 |
| Value of fidelity bond covering the plan | 2022-05-31 | $33,000 |
| Total contributions received or receivable from participants | 2022-05-31 | $88,288 |
| Expenses. Other expenses not covered elsewhere | 2022-05-31 | $107,068 |
| Contributions received from other sources (not participants or employers) | 2022-05-31 | $8,670 |
| Net income (gross income less expenses) | 2022-05-31 | $-76,212 |
| Net plan assets at end of year (total assets less liabilities) | 2022-05-31 | $92,541 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-05-31 | $168,753 |
| Total contributions received or receivable from employer(s) | 2022-05-31 | $239,763 |
| Value of corrective distributions | 2022-05-31 | $62,140 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-05-31 | $12,984 |
| 2021 : BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-05-31 | $20,931 |
| Total plan liabilities at beginning of year | 2021-05-31 | $54,234 |
| Total income from all sources | 2021-05-31 | $435,868 |
| Expenses. Total of all expenses incurred | 2021-05-31 | $268,944 |
| Benefits paid (including direct rollovers) | 2021-05-31 | $92,300 |
| Total plan assets at end of year | 2021-05-31 | $189,684 |
| Total plan assets at beginning of year | 2021-05-31 | $56,063 |
| Value of fidelity bond covering the plan | 2021-05-31 | $33,000 |
| Total contributions received or receivable from participants | 2021-05-31 | $160,220 |
| Expenses. Other expenses not covered elsewhere | 2021-05-31 | $126,271 |
| Contributions received from other sources (not participants or employers) | 2021-05-31 | $8,080 |
| Other income received | 2021-05-31 | $0 |
| Net income (gross income less expenses) | 2021-05-31 | $166,924 |
| Net plan assets at end of year (total assets less liabilities) | 2021-05-31 | $168,753 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-05-31 | $1,829 |
| Total contributions received or receivable from employer(s) | 2021-05-31 | $267,568 |
| Value of corrective distributions | 2021-05-31 | $33,586 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-05-31 | $16,787 |
| 2020 : BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-05-31 | $54,234 |
| Total plan liabilities at beginning of year | 2020-05-31 | $0 |
| Total income from all sources | 2020-05-31 | $564,376 |
| Expenses. Total of all expenses incurred | 2020-05-31 | $562,547 |
| Benefits paid (including direct rollovers) | 2020-05-31 | $373,679 |
| Total plan assets at end of year | 2020-05-31 | $56,063 |
| Total plan assets at beginning of year | 2020-05-31 | $0 |
| Value of fidelity bond covering the plan | 2020-05-31 | $33,000 |
| Total contributions received or receivable from participants | 2020-05-31 | $149,182 |
| Expenses. Other expenses not covered elsewhere | 2020-05-31 | $164,607 |
| Contributions received from other sources (not participants or employers) | 2020-05-31 | $22,119 |
| Other income received | 2020-05-31 | $0 |
| Net income (gross income less expenses) | 2020-05-31 | $1,829 |
| Net plan assets at end of year (total assets less liabilities) | 2020-05-31 | $1,829 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-05-31 | $0 |
| Total contributions received or receivable from employer(s) | 2020-05-31 | $393,075 |
| Value of corrective distributions | 2020-05-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-05-31 | $24,261 |
| 2023: BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-06-01 | Type of plan entity | Single employer plan |
| 2023-06-01 | Submission has been amended | No |
| 2023-06-01 | This submission is the final filing | No |
| 2023-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-06-01 | Plan is a collectively bargained plan | No |
| 2023-06-01 | Plan funding arrangement – Insurance | Yes |
| 2023-06-01 | Plan funding arrangement – Trust | Yes |
| 2023-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-06-01 | Plan benefit arrangement - Trust | Yes |
| 2023-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Submission has been amended | No |
| 2022-06-01 | This submission is the final filing | No |
| 2022-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-06-01 | Plan is a collectively bargained plan | No |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – Trust | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement - Trust | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Submission has been amended | No |
| 2021-06-01 | This submission is the final filing | No |
| 2021-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-06-01 | Plan is a collectively bargained plan | No |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – Trust | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement - Trust | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Submission has been amended | No |
| 2020-06-01 | This submission is the final filing | No |
| 2020-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-06-01 | Plan is a collectively bargained plan | No |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – Trust | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement - Trust | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: BW HEALTH GROUP, LLC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | First time form 5500 has been submitted | Yes |
| 2019-06-01 | Submission has been amended | No |
| 2019-06-01 | This submission is the final filing | No |
| 2019-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-06-01 | Plan is a collectively bargained plan | No |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – Trust | Yes |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement - Trust | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM19060030 |
| Policy instance | 8 |
| Insurance contract or identification number | DM19060030 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $205 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 1 |
| Insurance contract or identification number | G000BK59 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $1,904 | | Total amount of fees paid to insurance company | USD $717 | | 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 | 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 $15,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 2 |
| Insurance contract or identification number | G000BK59 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $1,306 | | Total amount of fees paid to insurance company | USD $494 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $10,882 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 3 |
| Insurance contract or identification number | G000BK59 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $2,794 | | Total amount of fees paid to insurance company | USD $1,081 | | 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 | Yes | | 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 $23,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BK59 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $450 | | Total amount of fees paid to insurance company | USD $175 | | 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 | VOLUNTARY LIFE & AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,751 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00036903 |
| Policy instance | 5 |
| Insurance contract or identification number | 00036903 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $2,526 | | Total amount of fees paid to insurance company | USD $1,504 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $35,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 31000060 |
| Policy instance | 6 |
| Insurance contract or identification number | 31000060 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2023-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $14,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 408741-A |
| Policy instance | 7 |
| Insurance contract or identification number | 408741-A | | Number of Individuals Covered | 55 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-05-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $206,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 1 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 4 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00036903 |
| Policy instance | 5 |
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ7600777H0005A |
| Policy instance | 6 |
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 7466 |
| Policy instance | 7 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 31000060 |
| Policy instance | 8 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM19060030 |
| Policy instance | 8 |
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 7466 |
| Policy instance | 7 |
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ7600777H0005A |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D042415 |
| Policy instance | 5 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 4 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 31000060 |
| Policy instance | 9 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 1 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 4 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5959043 |
| Policy instance | 5 |
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ7600777H0005A |
| Policy instance | 6 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM19060031 |
| Policy instance | 8 |
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 7466 |
| Policy instance | 7 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 31000060 |
| Policy instance | 9 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 4 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5959043 |
| Policy instance | 5 |
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ7600777H0005A |
| Policy instance | 6 |
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 6670 |
| Policy instance | 7 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM19060031 |
| Policy instance | 8 |
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 19060031 |
| Policy instance | 9 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 31000060 |
| Policy instance | 10 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BK59 |
| Policy instance | 1 |
