GUNN-MOWERY LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN
| Measure | Date | Value |
|---|
| 2023 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-12-31 | $110,980 |
| Total plan liabilities at beginning of year | 2023-12-31 | $93,918 |
| Total income from all sources | 2023-12-31 | $688,077 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $721,929 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $441,149 |
| Total plan assets at end of year | 2023-12-31 | $134,136 |
| Total plan assets at beginning of year | 2023-12-31 | $150,926 |
| Value of fidelity bond covering the plan | 2023-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2023-12-31 | $124,728 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $198,408 |
| Contributions received from other sources (not participants or employers) | 2023-12-31 | $12,799 |
| Other income received | 2023-12-31 | $1,832 |
| Net income (gross income less expenses) | 2023-12-31 | $-33,852 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $23,156 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $57,008 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $548,718 |
| Value of corrective distributions | 2023-12-31 | $80,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $2,372 |
| 2022 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $93,918 |
| Total plan liabilities at beginning of year | 2022-12-31 | $63,570 |
| Total income from all sources | 2022-12-31 | $663,139 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $783,586 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $509,570 |
| Total plan assets at end of year | 2022-12-31 | $150,926 |
| Total plan assets at beginning of year | 2022-12-31 | $241,025 |
| Value of fidelity bond covering the plan | 2022-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $86,635 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $182,962 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $8,428 |
| Other income received | 2022-12-31 | $529 |
| Net income (gross income less expenses) | 2022-12-31 | $-120,447 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $57,008 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $177,455 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $567,547 |
| Value of corrective distributions | 2022-12-31 | $80,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $11,054 |
| 2021 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $63,570 |
| Total plan liabilities at beginning of year | 2021-12-31 | $50,940 |
| Total income from all sources | 2021-12-31 | $682,178 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $747,182 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $536,041 |
| Total plan assets at end of year | 2021-12-31 | $241,025 |
| Total plan assets at beginning of year | 2021-12-31 | $293,399 |
| Value of fidelity bond covering the plan | 2021-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $168,348 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $172,365 |
| Other income received | 2021-12-31 | $165 |
| Net income (gross income less expenses) | 2021-12-31 | $-65,004 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $177,455 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $242,459 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $513,665 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $38,776 |
| 2020 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $50,940 |
| Total plan liabilities at beginning of year | 2020-12-31 | $70,815 |
| Total income from all sources | 2020-12-31 | $684,910 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $567,089 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $373,968 |
| Total plan assets at end of year | 2020-12-31 | $293,399 |
| Total plan assets at beginning of year | 2020-12-31 | $195,453 |
| Value of fidelity bond covering the plan | 2020-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $163,338 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $151,710 |
| Other income received | 2020-12-31 | $362 |
| Net income (gross income less expenses) | 2020-12-31 | $117,821 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $242,459 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $124,638 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $521,210 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $41,411 |
| 2019 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $70,815 |
| Total plan liabilities at beginning of year | 2019-12-31 | $70,652 |
| Total income from all sources | 2019-12-31 | $732,820 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $713,501 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $508,686 |
| Total plan assets at end of year | 2019-12-31 | $195,453 |
| Total plan assets at beginning of year | 2019-12-31 | $175,971 |
| Value of fidelity bond covering the plan | 2019-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $145,529 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $155,925 |
| Other income received | 2019-12-31 | $363 |
| Net income (gross income less expenses) | 2019-12-31 | $19,319 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $124,638 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $105,319 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $586,928 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $48,890 |
| 2018 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $70,652 |
| Total plan liabilities at beginning of year | 2018-12-31 | $321,619 |
| Total income from all sources | 2018-12-31 | $672,646 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $472,739 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $275,152 |
| Total plan assets at end of year | 2018-12-31 | $175,971 |
| Total plan assets at beginning of year | 2018-12-31 | $227,031 |
| Value of fidelity bond covering the plan | 2018-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $101,238 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $143,269 |
| Other income received | 2018-12-31 | $230 |
| Net income (gross income less expenses) | 2018-12-31 | $199,907 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $105,319 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-94,588 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $571,178 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $54,318 |
| 2017 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $321,619 |
| Total plan liabilities at beginning of year | 2017-12-31 | $98,379 |
| Total income from all sources | 2017-12-31 | $569,889 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $710,287 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $527,939 |
| Total plan assets at end of year | 2017-12-31 | $227,031 |
| Total plan assets at beginning of year | 2017-12-31 | $144,189 |
| Value of fidelity bond covering the plan | 2017-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $108,644 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $124,646 |
| Other income received | 2017-12-31 | $111 |
| Net income (gross income less expenses) | 2017-12-31 | $-140,398 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $-94,588 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $45,810 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $461,134 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $57,702 |
| 2016 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $98,379 |
| Total plan liabilities at beginning of year | 2016-12-31 | $42,705 |
| Total income from all sources | 2016-12-31 | $538,700 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $655,790 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $484,638 |
| Total plan assets at end of year | 2016-12-31 | $144,189 |
| Total plan assets at beginning of year | 2016-12-31 | $205,605 |
| Value of fidelity bond covering the plan | 2016-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $107,042 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $114,448 |
| Other income received | 2016-12-31 | $381 |
| Net income (gross income less expenses) | 2016-12-31 | $-117,090 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $45,810 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $162,900 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $431,277 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $56,704 |
| 2014 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $38,040 |
| Total plan liabilities at beginning of year | 2014-12-31 | $35,638 |
| Total income from all sources | 2014-12-31 | $416,610 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $428,006 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $291,549 |
| Total plan assets at end of year | 2014-12-31 | $71,735 |
| Total plan assets at beginning of year | 2014-12-31 | $80,729 |
| Value of fidelity bond covering the plan | 2014-12-31 | $2,000,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $299,811 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $87,483 |
| Other income received | 2014-12-31 | $72 |
| Net income (gross income less expenses) | 2014-12-31 | $-11,396 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $33,695 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $45,091 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $116,727 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $48,974 |
| 2013 : GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $35,638 |
| Total income from all sources | 2013-12-31 | $357,161 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $312,070 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $193,809 |
| Total plan assets at end of year | 2013-12-31 | $80,729 |
| Value of fidelity bond covering the plan | 2013-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $102,199 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $76,667 |
| Other income received | 2013-12-31 | $11,500 |
| Net income (gross income less expenses) | 2013-12-31 | $45,091 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $45,091 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $243,462 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $41,594 |
| 2023: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: GUNN-MOWERY EMPLOYEE HEALTH & LIFE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 7 |
| Insurance contract or identification number | 4168 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30800005 |
| Policy instance | 1 |
| Insurance contract or identification number | 30800005 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $177,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| Insurance contract or identification number | 225343 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $1,631 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| Insurance contract or identification number | 507561 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $17,222 | | Total amount of fees paid to insurance company | USD $508 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 132914 |
| Policy instance | 4 |
| Insurance contract or identification number | 132914 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,251 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LIFESTYLE ADD; LIFESTYLE LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 5 |
| Insurance contract or identification number | 4167 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 526812 |
| Policy instance | 6 |
| Insurance contract or identification number | 526812 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $3,622 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LONG TERM CARE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $36,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30800005 |
| Policy instance | 1 |
| Insurance contract or identification number | 30800005 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $162,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| Insurance contract or identification number | 225343 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,748 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| Insurance contract or identification number | 507561 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $152 | | Total amount of fees paid to insurance company | USD $11 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $30,947 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 132914 |
| Policy instance | 4 |
| Insurance contract or identification number | 132914 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,901 | | Total amount of fees paid to insurance company | USD $95 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LIFESTYLE ADD; LIFESTYLE LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 5 |
| Insurance contract or identification number | 4167 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 526812 |
| Policy instance | 6 |
| Insurance contract or identification number | 526812 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $687 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LONG TERM CARE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 7 |
| Insurance contract or identification number | 4168 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30800005 |
| Policy instance | 1 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 4 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 132914 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 132914 |
| Policy instance | 6 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 5 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30800005 |
| Policy instance | 1 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 5 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 132914 |
| Policy instance | 6 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 132914 |
| Policy instance | 6 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 5 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 225343 |
| Policy instance | 2 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4168 |
| Policy instance | 5 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4167 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 507561 |
| Policy instance | 3 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1040133 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
