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AFFORDABLE CARE, INC HEALTH PLAN 401k Plan overview

Plan NameAFFORDABLE CARE, INC HEALTH PLAN
Plan identification number 503

AFFORDABLE CARE, INC HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Vision

401k Sponsoring company profile

AFFORDABLE CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:AFFORDABLE CARE, LLC
Employer identification number (EIN):561505559
NAIC Classification:621210
NAIC Description:Offices of Dentists

Additional information about AFFORDABLE CARE, LLC

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 2003-04-11
Company Identification Number: 75603
Legal Registered Office Address: 400 CORNERSTONE DR #240

WILLISTON
United States of America (USA)
05495

More information about AFFORDABLE CARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AFFORDABLE CARE, INC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01JEREMY W. REYNOLDS2023-10-13
5032021-01-01JEREMY W. REYNOLDS2022-10-13
5032020-01-01
5032019-01-01
5032018-01-01
5032017-01-01JEREMY REYNOLDS
5032016-01-01PAUL STEELMAN
5032015-01-01PAUL STEELMAN
5032014-01-01PAUL STEELMAN
5032013-01-01PAUL STEELMAN PAUL STEELMAN2014-07-23
5032012-01-01PAUL STEELMAN
5032011-01-01PAUL STEELMAN
5032009-01-01 PAUL STEELMAN2010-07-29

Plan Statistics for AFFORDABLE CARE, INC HEALTH PLAN

401k plan membership statisitcs for AFFORDABLE CARE, INC HEALTH PLAN

Measure Date Value
2022: AFFORDABLE CARE, INC HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-012,118
Total number of active participants reported on line 7a of the Form 55002022-01-012,244
Number of retired or separated participants receiving benefits2022-01-0136
Number of other retired or separated participants entitled to future benefits2022-01-01148
Total of all active and inactive participants2022-01-012,428
Number of employers contributing to the scheme2022-01-010
2021: AFFORDABLE CARE, INC HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-012,273
Total number of active participants reported on line 7a of the Form 55002021-01-012,097
Number of retired or separated participants receiving benefits2021-01-0121
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-012,118
Number of employers contributing to the scheme2021-01-010
2020: AFFORDABLE CARE, INC HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-012,301
Total number of active participants reported on line 7a of the Form 55002020-01-012,186
Number of retired or separated participants receiving benefits2020-01-0124
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-012,210
2019: AFFORDABLE CARE, INC HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,822
Total number of active participants reported on line 7a of the Form 55002019-01-011,738
Number of retired or separated participants receiving benefits2019-01-0120
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,758
2018: AFFORDABLE CARE, INC HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,768
Total number of active participants reported on line 7a of the Form 55002018-01-011,626
Number of retired or separated participants receiving benefits2018-01-0118
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,644
2017: AFFORDABLE CARE, INC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,641
Total number of active participants reported on line 7a of the Form 55002017-01-011,666
Number of retired or separated participants receiving benefits2017-01-019
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-011,675
2016: AFFORDABLE CARE, INC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,570
Total number of active participants reported on line 7a of the Form 55002016-01-011,563
Number of retired or separated participants receiving benefits2016-01-016
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,569
2015: AFFORDABLE CARE, INC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,596
Total number of active participants reported on line 7a of the Form 55002015-01-011,530
Number of retired or separated participants receiving benefits2015-01-018
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,538
2014: AFFORDABLE CARE, INC HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,522
Total number of active participants reported on line 7a of the Form 55002014-01-011,553
Total of all active and inactive participants2014-01-011,553
Total participants2014-01-011,553
2013: AFFORDABLE CARE, INC HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,440
Total number of active participants reported on line 7a of the Form 55002013-01-011,522
Total of all active and inactive participants2013-01-011,522
Total participants2013-01-011,522
2012: AFFORDABLE CARE, INC HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,568
Total number of active participants reported on line 7a of the Form 55002012-01-011,700
Total of all active and inactive participants2012-01-011,700
Total participants2012-01-011,700
2011: AFFORDABLE CARE, INC HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,302
Total number of active participants reported on line 7a of the Form 55002011-01-011,337
Total of all active and inactive participants2011-01-011,337
Total participants2011-01-011,337
2009: AFFORDABLE CARE, INC HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,510
Total number of active participants reported on line 7a of the Form 55002009-01-011,638
Total of all active and inactive participants2009-01-011,638
Total participants2009-01-011,638
Number of employers contributing to the scheme2009-01-01152

Form 5500 Responses for AFFORDABLE CARE, INC HEALTH PLAN

2022: AFFORDABLE CARE, INC HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AFFORDABLE CARE, INC HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AFFORDABLE CARE, INC HEALTH 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 – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: AFFORDABLE CARE, INC HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: AFFORDABLE CARE, INC HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: AFFORDABLE CARE, INC HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: AFFORDABLE CARE, INC HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: AFFORDABLE CARE, INC HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: AFFORDABLE CARE, INC HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: AFFORDABLE CARE, INC HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: AFFORDABLE CARE, INC HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: AFFORDABLE CARE, INC HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: AFFORDABLE CARE, INC HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number703412
Policy instance 1
Insurance contract or identification number703412
Number of Individuals Covered2454
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
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?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
Welfare Benefit Premiums Paid to CarrierUSD $562,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009295
Policy instance 1
Insurance contract or identification number009295
Number of Individuals Covered696
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $189,520
Are there contracts with allocated funds for individual policies?No
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?No
Health Insurance Welfare BenefitYes
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 $1,348
Insurance broker nameLOCKTON COMPANIES LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4010510010
Policy instance 3
Insurance contract or identification number4010510010
Number of Individuals Covered1553
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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
UNITED HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number703412
Policy instance 2
Insurance contract or identification number703412
Number of Individuals Covered857
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $490,650
Are there contracts with allocated funds for individual policies?No
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?No
Health Insurance Welfare BenefitYes
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
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009295
Policy instance 1
Insurance contract or identification number009295
Number of Individuals Covered660
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
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?No
Health Insurance Welfare BenefitYes
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
UNITED HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number703412
Policy instance 2
Insurance contract or identification number703412
Number of Individuals Covered862
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
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?No
Health Insurance Welfare BenefitYes
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
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number401051 0010
Policy instance 3
Insurance contract or identification number401051 0010
Number of Individuals Covered1522
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?No
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?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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LC
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009295
Policy instance 1
Insurance contract or identification number009295
Number of Individuals Covered655
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of fees paid to insurance companyUSD $187,801
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
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 number401051
Policy instance 3
Insurance contract or identification number401051
Number of Individuals Covered1434
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $60,851
Welfare Benefit Premiums Paid to CarrierUSD $405,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees60851
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
UNITED HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number703412
Policy instance 2
Insurance contract or identification number703412
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of fees paid to insurance companyUSD $501,512
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number009295
Policy instance 1
Insurance contract or identification number009295
Number of Individuals Covered392
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $185,648
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number703412
Policy instance 2
Insurance contract or identification number703412
Number of Individuals Covered945
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $443,275
Health Insurance Welfare BenefitYes
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 number4010510010
Policy instance 3
Insurance contract or identification number4010510010
Number of Individuals Covered1337
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $52,935
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $352,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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