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ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN
Plan identification number 501

ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

ALAN C. TURNHAM, MD, PA has sponsored the creation of one or more 401k plans.

Company Name:ALAN C. TURNHAM, MD, PA
Employer identification number (EIN):630794908
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01
5012020-12-01
5012019-12-01
5012018-12-01
5012018-12-01
5012017-12-01ALAN TURNHAM2019-05-01
5012016-12-01
5012015-12-01
5012014-12-01ALAN TURNHAM
5012013-12-01ALAN TURNHAM
5012012-12-01ALAN TURNHAM
5012011-12-01ALAN TURNHAM
5012009-12-01ALAN TURNHAM
5012009-12-01ALAN TURNHAM

Plan Statistics for ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN

Measure Date Value
2021: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-012
Total number of active participants reported on line 7a of the Form 55002021-12-012
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-012
2020: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-012
Total number of active participants reported on line 7a of the Form 55002020-12-012
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-012
2019: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-013
Total number of active participants reported on line 7a of the Form 55002019-12-013
Number of retired or separated participants receiving benefits2019-12-010
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-013
2018: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-013
Total number of active participants reported on line 7a of the Form 55002018-12-013
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-013
2017: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-013
Total number of active participants reported on line 7a of the Form 55002017-12-013
Number of retired or separated participants receiving benefits2017-12-010
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-013
2016: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-013
Total number of active participants reported on line 7a of the Form 55002016-12-013
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-013
2015: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-013
Total number of active participants reported on line 7a of the Form 55002015-12-013
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-013
2014: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-013
Total number of active participants reported on line 7a of the Form 55002014-12-013
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-013
2013: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-013
Total number of active participants reported on line 7a of the Form 55002013-12-013
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-013
2012: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-013
Total number of active participants reported on line 7a of the Form 55002012-12-013
Number of retired or separated participants receiving benefits2012-12-010
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-013
2011: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-013
Total number of active participants reported on line 7a of the Form 55002011-12-013
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-013
2009: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-013
Total number of active participants reported on line 7a of the Form 55002009-12-013
Number of retired or separated participants receiving benefits2009-12-010
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-013

Financial Data on ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN

Measure Date Value
2022 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-11-30$311,743
Total plan liabilities at beginning of year2022-11-30$311,743
Total income from all sources2022-11-30$0
Expenses. Total of all expenses incurred2022-11-30$0
Total plan assets at end of year2022-11-30$311,743
Total plan assets at beginning of year2022-11-30$311,743
Net income (gross income less expenses)2022-11-30$0
Net plan assets at end of year (total assets less liabilities)2022-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2022-11-30$0
2021 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-11-30$311,743
Total plan liabilities at beginning of year2021-11-30$302,605
Total income from all sources2021-11-30$0
Expenses. Total of all expenses incurred2021-11-30$0
Total plan assets at end of year2021-11-30$311,743
Total plan assets at beginning of year2021-11-30$302,605
Net income (gross income less expenses)2021-11-30$0
Net plan assets at end of year (total assets less liabilities)2021-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2021-11-30$0
2020 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-11-30$302,605
Total plan liabilities at beginning of year2020-11-30$293,738
Total income from all sources2020-11-30$0
Expenses. Total of all expenses incurred2020-11-30$0
Total plan assets at end of year2020-11-30$302,605
Total plan assets at beginning of year2020-11-30$293,738
Net income (gross income less expenses)2020-11-30$0
Net plan assets at end of year (total assets less liabilities)2020-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2020-11-30$0
2019 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-11-30$293,738
Total plan liabilities at beginning of year2019-11-30$285,132
Total income from all sources2019-11-30$0
Expenses. Total of all expenses incurred2019-11-30$0
Total plan assets at end of year2019-11-30$293,738
Total plan assets at beginning of year2019-11-30$285,132
Net income (gross income less expenses)2019-11-30$0
Net plan assets at end of year (total assets less liabilities)2019-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-11-30$0
2017 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-11-30$276,782
Total plan liabilities at beginning of year2017-11-30$268,679
Total income from all sources2017-11-30$0
Expenses. Total of all expenses incurred2017-11-30$0
Total plan assets at end of year2017-11-30$276,782
Total plan assets at beginning of year2017-11-30$268,679
Net income (gross income less expenses)2017-11-30$0
Net plan assets at end of year (total assets less liabilities)2017-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-11-30$0
2016 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-11-30$268,679
Total plan liabilities at beginning of year2016-11-30$260,794
Total income from all sources2016-11-30$0
Expenses. Total of all expenses incurred2016-11-30$0
Total plan assets at end of year2016-11-30$268,679
Total plan assets at beginning of year2016-11-30$260,794
Net income (gross income less expenses)2016-11-30$0
Net plan assets at end of year (total assets less liabilities)2016-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2016-11-30$0
2015 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-11-30$260,794
Total plan liabilities at beginning of year2015-11-30$253,164
Total income from all sources2015-11-30$0
Expenses. Total of all expenses incurred2015-11-30$0
Total plan assets at end of year2015-11-30$260,794
Total plan assets at beginning of year2015-11-30$253,164
Net income (gross income less expenses)2015-11-30$0
Net plan assets at end of year (total assets less liabilities)2015-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2015-11-30$0
2014 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-11-30$253,164
Total plan liabilities at beginning of year2014-11-30$245,745
Total income from all sources2014-11-30$0
Expenses. Total of all expenses incurred2014-11-30$0
Total plan assets at end of year2014-11-30$253,164
Total plan assets at beginning of year2014-11-30$245,745
Net income (gross income less expenses)2014-11-30$0
Net plan assets at end of year (total assets less liabilities)2014-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2014-11-30$0
2013 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2013 401k financial data
Total plan liabilities at end of year2013-11-30$245,745
Total plan liabilities at beginning of year2013-11-30$237,473
Total income from all sources2013-11-30$2,810
Expenses. Total of all expenses incurred2013-11-30$2,810
Total plan assets at end of year2013-11-30$245,745
Total plan assets at beginning of year2013-11-30$237,473
Expenses. Other expenses not covered elsewhere2013-11-30$2,810
Net income (gross income less expenses)2013-11-30$0
Net plan assets at end of year (total assets less liabilities)2013-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2013-11-30$0
Total contributions received or receivable from employer(s)2013-11-30$2,810
2012 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2012 401k financial data
Total plan liabilities at end of year2012-11-30$237,473
Total plan liabilities at beginning of year2012-11-30$139,998
Total income from all sources2012-11-30$107,900
Expenses. Total of all expenses incurred2012-11-30$107,900
Total plan assets at end of year2012-11-30$237,473
Total plan assets at beginning of year2012-11-30$139,998
Expenses. Other expenses not covered elsewhere2012-11-30$106,510
Other income received2012-11-30$5
Net income (gross income less expenses)2012-11-30$0
Net plan assets at end of year (total assets less liabilities)2012-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2012-11-30$0
Total contributions received or receivable from employer(s)2012-11-30$107,895
Expenses. Administrative service providers (salaries,fees and commissions)2012-11-30$1,390
2011 : ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2011 401k financial data
Total plan liabilities at end of year2011-11-30$136,991
Total plan liabilities at beginning of year2011-11-30$49,885
Total income from all sources2011-11-30$106,314
Expenses. Total of all expenses incurred2011-11-30$106,314
Total plan assets at end of year2011-11-30$136,991
Total plan assets at beginning of year2011-11-30$49,968
Expenses. Other expenses not covered elsewhere2011-11-30$104,924
Net income (gross income less expenses)2011-11-30$0
Net plan assets at end of year (total assets less liabilities)2011-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2011-11-30$83
Total contributions received or receivable from employer(s)2011-11-30$106,314
Expenses. Administrative service providers (salaries,fees and commissions)2011-11-30$1,390

Form 5500 Responses for ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN

2021: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2020: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2019: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2018: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2017: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2016: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2013: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes
2012: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan funding arrangement – TrustYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement - TrustYes
2011: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement - TrustYes
2009: ALAN C. TURNHAM M.D., P.A. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01First time form 5500 has been submittedYes
2009-12-01Submission has been amendedYes
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – TrustYes
2009-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
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?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
Other welfare benefits providedANNUITY
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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?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
Other welfare benefits providedANNUITY
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
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
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?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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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?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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
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?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
Other welfare benefits providedANNUITY
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
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2015-12-01
Insurance policy end date2016-11-30
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?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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameEMMETT COE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
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?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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameEMMETT COE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
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?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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameEMMETT COE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,810
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
Other welfare benefits providedANNUITY
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
Amount paid for insurance broker fees2810
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameEMMETT COE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberFA-566-5462
Policy instance 1
Insurance contract or identification numberFA-566-5462
Number of Individuals Covered3
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $2,590
Total amount of fees paid to insurance companyUSD $1,390
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
Other welfare benefits providedANNUITY
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
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number5462
Policy instance 1
Insurance contract or identification number5462
Number of Individuals Covered3
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $2,623
Total amount of fees paid to insurance companyUSD $1,390
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

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