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LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 401k Plan overview

Plan NameLEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN
Plan identification number 503

LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TRI-STARR MGMT SVCS D/B/A LEGACY SUPPLY CHAIN SVCS has sponsored the creation of one or more 401k plans.

Company Name:TRI-STARR MGMT SVCS D/B/A LEGACY SUPPLY CHAIN SVCS
Employer identification number (EIN):742616688
NAIC Classification:561300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032024-04-01ALTHEA MOTHERSILL
5032023-04-01
5032023-04-01ALTHEA MOTHERSILL
5032022-04-01
5032022-04-01JOANNA PENCAK
5032021-04-01
5032021-04-01JOANNA PENCAK
5032020-04-01
5032019-04-01
5032018-04-01
5032017-04-01JOANNA PENCAK
5032016-04-01NANCY CANNONE

Financial Data on LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN

Measure Date Value
2020 : LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$794,147
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$627,731
Total income from all sources (including contributions)2020-03-31$8,745,962
Total of all expenses incurred2020-03-31$9,401,590
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$8,772,030
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$8,745,962
Value of total assets at end of year2020-03-31$0
Value of total assets at beginning of year2020-03-31$489,212
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$629,560
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Was this plan covered by a fidelity bond2020-03-31Yes
Value of fidelity bond cover2020-03-31$2,000,000
If this is an individual account plan, was there a blackout period2020-03-31No
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Contributions received from participants2020-03-31$3,003,416
Participant contributions at end of year2020-03-31$0
Participant contributions at beginning of year2020-03-31$39,981
Income. Received or receivable in cash from other sources (including rollovers)2020-03-31$702,068
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-03-31$16,973
Administrative expenses (other) incurred2020-03-31$37,213
Liabilities. Value of operating payables at end of year2020-03-31$0
Liabilities. Value of operating payables at beginning of year2020-03-31$105,862
Total non interest bearing cash at end of year2020-03-31$0
Total non interest bearing cash at beginning of year2020-03-31$100,029
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Value of net income/loss2020-03-31$-655,628
Value of net assets at end of year (total assets less liabilities)2020-03-31$-794,147
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$-138,519
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Investment advisory and management fees2020-03-31$109,201
Expenses. Payments to insurance carriers foe the provision of benefits2020-03-31$1,641,994
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Contributions received in cash from employer2020-03-31$5,040,478
Employer contributions (assets) at end of year2020-03-31$0
Employer contributions (assets) at beginning of year2020-03-31$332,229
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-03-31$7,130,036
Contract administrator fees2020-03-31$483,146
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-03-31No
Liabilities. Value of benefit claims payable at end of year2020-03-31$794,147
Liabilities. Value of benefit claims payable at beginning of year2020-03-31$521,869
Did the plan have assets held for investment2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-03-31No
Opinion of an independent qualified public accountant for this plan2020-03-31Unqualified
Accountancy firm name2020-03-31ENNIS, PELLUM & ASSOCIATES, CPAS
Accountancy firm EIN2020-03-31591843700
2019 : LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-03-31$627,731
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-03-31$941,291
Total income from all sources (including contributions)2019-03-31$8,019,210
Total of all expenses incurred2019-03-31$7,775,539
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-03-31$7,219,317
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-03-31$8,019,210
Value of total assets at end of year2019-03-31$489,212
Value of total assets at beginning of year2019-03-31$559,101
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-03-31$556,222
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-03-31No
Was this plan covered by a fidelity bond2019-03-31Yes
Value of fidelity bond cover2019-03-31$2,000,000
If this is an individual account plan, was there a blackout period2019-03-31No
Were there any nonexempt tranactions with any party-in-interest2019-03-31No
Contributions received from participants2019-03-31$2,878,693
Participant contributions at end of year2019-03-31$39,981
Participant contributions at beginning of year2019-03-31$57,885
Income. Received or receivable in cash from other sources (including rollovers)2019-03-31$649,367
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-03-31$16,973
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-03-31$16,973
Administrative expenses (other) incurred2019-03-31$44,673
Liabilities. Value of operating payables at end of year2019-03-31$105,862
Liabilities. Value of operating payables at beginning of year2019-03-31$132,319
Total non interest bearing cash at end of year2019-03-31$100,029
Total non interest bearing cash at beginning of year2019-03-31$89,508
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Value of net income/loss2019-03-31$243,671
Value of net assets at end of year (total assets less liabilities)2019-03-31$-138,519
Value of net assets at beginning of year (total assets less liabilities)2019-03-31$-382,190
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-03-31No
Were any leases to which the plan was party in default or uncollectible2019-03-31No
Investment advisory and management fees2019-03-31$107,469
Expenses. Payments to insurance carriers foe the provision of benefits2019-03-31$1,152,270
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-03-31No
Was there a failure to transmit to the plan any participant contributions2019-03-31No
Has the plan failed to provide any benefit when due under the plan2019-03-31No
Contributions received in cash from employer2019-03-31$4,491,150
Employer contributions (assets) at end of year2019-03-31$332,229
Employer contributions (assets) at beginning of year2019-03-31$394,735
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-03-31$6,067,047
Contract administrator fees2019-03-31$404,080
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-03-31No
Liabilities. Value of benefit claims payable at end of year2019-03-31$521,869
Liabilities. Value of benefit claims payable at beginning of year2019-03-31$808,972
Did the plan have assets held for investment2019-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-03-31No
Opinion of an independent qualified public accountant for this plan2019-03-31Unqualified
Accountancy firm name2019-03-31ENNIS, PELLUM & ASSOCIATES, CPAS
Accountancy firm EIN2019-03-31591843700
2018 : LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$941,291
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$546,867
Total income from all sources (including contributions)2018-03-31$7,600,900
Total of all expenses incurred2018-03-31$7,928,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-03-31$7,388,599
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-03-31$7,600,900
Value of total assets at end of year2018-03-31$559,101
Value of total assets at beginning of year2018-03-31$492,637
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-03-31$540,261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-03-31No
Was this plan covered by a fidelity bond2018-03-31Yes
Value of fidelity bond cover2018-03-31$500,000
If this is an individual account plan, was there a blackout period2018-03-31No
Were there any nonexempt tranactions with any party-in-interest2018-03-31No
Contributions received from participants2018-03-31$2,800,667
Participant contributions at end of year2018-03-31$57,885
Participant contributions at beginning of year2018-03-31$49,671
Income. Received or receivable in cash from other sources (including rollovers)2018-03-31$161,130
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-03-31$16,973
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-03-31$16,973
Administrative expenses (other) incurred2018-03-31$29,685
Liabilities. Value of operating payables at end of year2018-03-31$132,319
Liabilities. Value of operating payables at beginning of year2018-03-31$185,231
Total non interest bearing cash at end of year2018-03-31$89,508
Total non interest bearing cash at beginning of year2018-03-31$167,852
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Value of net income/loss2018-03-31$-327,960
Value of net assets at end of year (total assets less liabilities)2018-03-31$-382,190
Value of net assets at beginning of year (total assets less liabilities)2018-03-31$-54,230
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-03-31No
Were any leases to which the plan was party in default or uncollectible2018-03-31No
Investment advisory and management fees2018-03-31$106,581
Expenses. Payments to insurance carriers foe the provision of benefits2018-03-31$1,306,566
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-03-31No
Was there a failure to transmit to the plan any participant contributions2018-03-31No
Has the plan failed to provide any benefit when due under the plan2018-03-31No
Contributions received in cash from employer2018-03-31$4,639,103
Employer contributions (assets) at end of year2018-03-31$394,735
Employer contributions (assets) at beginning of year2018-03-31$258,141
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-03-31$6,082,033
Contract administrator fees2018-03-31$403,995
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-03-31No
Liabilities. Value of benefit claims payable at end of year2018-03-31$808,972
Liabilities. Value of benefit claims payable at beginning of year2018-03-31$361,636
Did the plan have assets held for investment2018-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-03-31No
Opinion of an independent qualified public accountant for this plan2018-03-31Unqualified
Accountancy firm name2018-03-31ENNIS, PELLUM & ASSOCIATES, CPAS
Accountancy firm EIN2018-03-31591843700
2017 : LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$546,867
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$622,429
Total income from all sources (including contributions)2017-03-31$7,097,152
Total of all expenses incurred2017-03-31$7,098,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-03-31$6,444,613
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-03-31$7,097,152
Value of total assets at end of year2017-03-31$492,637
Value of total assets at beginning of year2017-03-31$569,700
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-03-31$654,040
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-03-31No
Was this plan covered by a fidelity bond2017-03-31Yes
Value of fidelity bond cover2017-03-31$500,000
If this is an individual account plan, was there a blackout period2017-03-31No
Were there any nonexempt tranactions with any party-in-interest2017-03-31No
Contributions received from participants2017-03-31$3,109,622
Participant contributions at end of year2017-03-31$49,671
Participant contributions at beginning of year2017-03-31$64,141
Income. Received or receivable in cash from other sources (including rollovers)2017-03-31$6,903
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-03-31$16,973
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-03-31$23,268
Administrative expenses (other) incurred2017-03-31$101,493
Liabilities. Value of operating payables at end of year2017-03-31$185,231
Liabilities. Value of operating payables at beginning of year2017-03-31$8,635
Total non interest bearing cash at end of year2017-03-31$167,852
Total non interest bearing cash at beginning of year2017-03-31$36,030
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Value of net income/loss2017-03-31$-1,501
Value of net assets at end of year (total assets less liabilities)2017-03-31$-54,230
Value of net assets at beginning of year (total assets less liabilities)2017-03-31$-52,729
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-03-31No
Were any leases to which the plan was party in default or uncollectible2017-03-31No
Investment advisory and management fees2017-03-31$117,832
Expenses. Payments to insurance carriers foe the provision of benefits2017-03-31$1,223,399
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-03-31No
Was there a failure to transmit to the plan any participant contributions2017-03-31No
Has the plan failed to provide any benefit when due under the plan2017-03-31No
Contributions received in cash from employer2017-03-31$3,980,627
Employer contributions (assets) at end of year2017-03-31$258,141
Employer contributions (assets) at beginning of year2017-03-31$446,261
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-03-31$5,221,214
Contract administrator fees2017-03-31$434,715
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-03-31No
Liabilities. Value of benefit claims payable at end of year2017-03-31$361,636
Liabilities. Value of benefit claims payable at beginning of year2017-03-31$613,794
Did the plan have assets held for investment2017-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-03-31No
Opinion of an independent qualified public accountant for this plan2017-03-31Unqualified
Accountancy firm name2017-03-31ENNIS, PELLUM & ASSOCIATES, CPAS
Accountancy firm EIN2017-03-31591843700

Form 5500 Responses for LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN

2023: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Submission has been amendedNo
2023-04-01This submission is the final filingNo
2023-04-01This return/report is a short plan year return/report (less than 12 months)No
2023-04-01Plan is a collectively bargained planNo
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan funding arrangement – General assets of the sponsorYes
2023-04-01Plan benefit arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – General assets of the sponsorYes
2022: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement - TrustYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement - TrustYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement - TrustYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: LEGACY SUPPLY CHAIN SERVICES WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681940G
Policy instance 2
Insurance contract or identification number681940G
Number of Individuals Covered1188
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $139,651
Total amount of fees paid to insurance companyUSD $94,711
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS, HOSPITAL INDEMNITY, AD&D, ACCIDENT
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 $865,790
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 number10443861001
Policy instance 1
Insurance contract or identification number10443861001
Number of Individuals Covered833
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $4,530
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
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 $58,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681940G
Policy instance 1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681940G
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 750577
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX962520
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 961850
Policy instance 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 964153
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberAI961044
Policy instance 8
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI961003
Policy instance 7
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX962520
Policy instance 6
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK964153
Policy instance 5
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK750577
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK961850
Policy instance 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number930449
Policy instance 2
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberGROUP HI/GAP
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX962520
Policy instance 6
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK964153
Policy instance 5
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK750577
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK961850
Policy instance 3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number405523-0010
Policy instance 2
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberGROUP HI/GAP
Policy instance 1
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number405523-0010
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK961850
Policy instance 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK750577
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK964153
Policy instance 5
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX962520
Policy instance 6
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract numberGROUP HI/GAP
Policy instance 1

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