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RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 401k Plan overview

Plan NameRUSSELL SIGLER INC. HEALTH PROTECTION PLAN
Plan identification number 501

RUSSELL SIGLER INC. HEALTH PROTECTION PLAN Benefits

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

401k Sponsoring company profile

RUSSELL SIGLER, INC. has sponsored the creation of one or more 401k plans.

Company Name:RUSSELL SIGLER, INC.
Employer identification number (EIN):860223222
NAIC Classification:423700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RUSSELL SIGLER INC. HEALTH PROTECTION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-06-01KIM JACKSON2024-09-18
5012022-06-01KIM JACKSON2023-12-08
5012021-06-01KIM JACKSON2022-12-12
5012020-06-01KIM JACKSON2021-08-17
5012019-06-01KIM JACKSON2020-12-13
5012017-06-01
5012016-06-01
5012015-06-01KIM H JACKSON
5012014-06-01KIM JACKSON
5012013-06-01KIM H JACKSON
5012012-06-01ROBERT D. OSBORNE
5012011-06-01ROBERT D. OSBORNE
5012010-06-01ROBERT D. OSBORNE
5012008-06-01ROBERT OSBORNE
5012007-06-01ROBERT OSBORNE
5012006-06-01ROBERT OSBORNE
5012005-06-01ROBERT OSBORNE
5012004-06-01ROBERT OSBORNE
5012003-06-01ROBERT OSBORNE
5012002-06-01ROBERT OSBORNE
5012001-06-01ROBERT OSBORNE
5012000-06-01ROBERT OSBORNE
5011999-06-01ROBERT OSBORNE

Plan Statistics for RUSSELL SIGLER INC. HEALTH PROTECTION PLAN

401k plan membership statisitcs for RUSSELL SIGLER INC. HEALTH PROTECTION PLAN

Measure Date Value
2023: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2023 401k membership
Total participants, beginning-of-year2023-06-01720
Total number of active participants reported on line 7a of the Form 55002023-06-01754
Number of retired or separated participants receiving benefits2023-06-010
Number of other retired or separated participants entitled to future benefits2023-06-010
Total of all active and inactive participants2023-06-01754
Number of employers contributing to the scheme2023-06-010
2022: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01704
Total number of active participants reported on line 7a of the Form 55002022-06-01725
Number of retired or separated participants receiving benefits2022-06-010
Number of other retired or separated participants entitled to future benefits2022-06-010
Total of all active and inactive participants2022-06-01725
Number of employers contributing to the scheme2022-06-010
2021: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01665
Total number of active participants reported on line 7a of the Form 55002021-06-01707
Number of retired or separated participants receiving benefits2021-06-010
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01707
Number of employers contributing to the scheme2021-06-010
2020: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01888
Total number of active participants reported on line 7a of the Form 55002020-06-01896
Number of retired or separated participants receiving benefits2020-06-010
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-01896
Number of employers contributing to the scheme2020-06-010
2019: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01677
Total number of active participants reported on line 7a of the Form 55002019-06-01888
Number of retired or separated participants receiving benefits2019-06-010
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01888
Number of employers contributing to the scheme2019-06-010
2017: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01682
Total number of active participants reported on line 7a of the Form 55002017-06-01627
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01627
Number of employers contributing to the scheme2017-06-010
2016: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01623
Total number of active participants reported on line 7a of the Form 55002016-06-01682
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01682
2015: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01536
Total number of active participants reported on line 7a of the Form 55002015-06-01623
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01623
2014: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01510
Total number of active participants reported on line 7a of the Form 55002014-06-01536
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01536
2013: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01530
Total number of active participants reported on line 7a of the Form 55002013-06-01510
Number of retired or separated participants receiving benefits2013-06-010
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01510
2012: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01536
Total number of active participants reported on line 7a of the Form 55002012-06-01530
Number of retired or separated participants receiving benefits2012-06-010
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-01530
2011: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01452
Total number of active participants reported on line 7a of the Form 55002011-06-01536
Number of retired or separated participants receiving benefits2011-06-010
Number of other retired or separated participants entitled to future benefits2011-06-010
Total of all active and inactive participants2011-06-01536
2010: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01157
Total number of active participants reported on line 7a of the Form 55002010-06-01452
Number of retired or separated participants receiving benefits2010-06-010
Number of other retired or separated participants entitled to future benefits2010-06-010
Total of all active and inactive participants2010-06-01452
2008: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2008 401k membership
Total participants, beginning-of-year2008-06-01253
Total number of active participants reported on line 7a of the Form 55002008-06-01217
Total of all active and inactive participants2008-06-01217
2007: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2007 401k membership
Total participants, beginning-of-year2007-06-01238
Total number of active participants reported on line 7a of the Form 55002007-06-01253
Total of all active and inactive participants2007-06-01253
2006: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2006 401k membership
Total participants, beginning-of-year2006-06-01217
Total number of active participants reported on line 7a of the Form 55002006-06-01238
Total of all active and inactive participants2006-06-01238
2005: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2005 401k membership
Total participants, beginning-of-year2005-06-01157
Total number of active participants reported on line 7a of the Form 55002005-06-01217
Total of all active and inactive participants2005-06-01217
2004: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2004 401k membership
Total participants, beginning-of-year2004-06-01159
Total number of active participants reported on line 7a of the Form 55002004-06-01157
Total of all active and inactive participants2004-06-01157
2003: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2003 401k membership
Total participants, beginning-of-year2003-06-01173
Total number of active participants reported on line 7a of the Form 55002003-06-01159
Total of all active and inactive participants2003-06-01159
2002: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2002 401k membership
Total participants, beginning-of-year2002-06-01163
Total number of active participants reported on line 7a of the Form 55002002-06-01173
Total of all active and inactive participants2002-06-01173
2001: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2001 401k membership
Total participants, beginning-of-year2001-06-01154
Total number of active participants reported on line 7a of the Form 55002001-06-01163
Total of all active and inactive participants2001-06-01163
2000: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2000 401k membership
Total participants, beginning-of-year2000-06-01154
Total number of active participants reported on line 7a of the Form 55002000-06-01154
Total of all active and inactive participants2000-06-01154
1999: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 1999 401k membership
Total participants, beginning-of-year1999-06-01151
Total number of active participants reported on line 7a of the Form 55001999-06-01154
Total of all active and inactive participants1999-06-01154

Form 5500 Responses for RUSSELL SIGLER INC. HEALTH PROTECTION PLAN

2023: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2023 form 5500 responses
2023-06-01Type of plan entitySingle employer plan
2023-06-01Plan funding arrangement – InsuranceYes
2023-06-01Plan funding arrangement – General assets of the sponsorYes
2023-06-01Plan benefit arrangement – InsuranceYes
2023-06-01Plan benefit arrangement – General assets of the sponsorYes
2022: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan funding arrangement – General assets of the sponsorYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – General assets of the sponsorYes
2021: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – General assets of the sponsorYes
2013: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – General assets of the sponsorYes
2012: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – General assets of the sponsorYes
2011: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – General assets of the sponsorYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – General assets of the sponsorYes
2010: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – General assets of the sponsorYes
2008: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2008 form 5500 responses
2008-06-01Type of plan entitySingle employer plan
2008-06-01This submission is the final filingNo
2008-06-01Plan funding arrangement – InsuranceYes
2008-06-01Plan funding arrangement – General assets of the sponsorYes
2008-06-01Plan benefit arrangement – InsuranceYes
2008-06-01Plan benefit arrangement – General assets of the sponsorYes
2007: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2007 form 5500 responses
2007-06-01Type of plan entitySingle employer plan
2007-06-01This submission is the final filingNo
2007-06-01Plan funding arrangement – InsuranceYes
2007-06-01Plan funding arrangement – General assets of the sponsorYes
2007-06-01Plan benefit arrangement – InsuranceYes
2007-06-01Plan benefit arrangement – General assets of the sponsorYes
2006: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2006 form 5500 responses
2006-06-01Type of plan entitySingle employer plan
2006-06-01This submission is the final filingNo
2006-06-01Plan funding arrangement – InsuranceYes
2006-06-01Plan funding arrangement – General assets of the sponsorYes
2006-06-01Plan benefit arrangement – InsuranceYes
2006-06-01Plan benefit arrangement – General assets of the sponsorYes
2005: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2005 form 5500 responses
2005-06-01Type of plan entitySingle employer plan
2005-06-01This submission is the final filingNo
2005-06-01Plan funding arrangement – InsuranceYes
2005-06-01Plan funding arrangement – General assets of the sponsorYes
2005-06-01Plan benefit arrangement – InsuranceYes
2005-06-01Plan benefit arrangement – General assets of the sponsorYes
2004: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2004 form 5500 responses
2004-06-01Type of plan entitySingle employer plan
2004-06-01This submission is the final filingNo
2004-06-01Plan funding arrangement – InsuranceYes
2004-06-01Plan funding arrangement – General assets of the sponsorYes
2004-06-01Plan benefit arrangement – InsuranceYes
2004-06-01Plan benefit arrangement – General assets of the sponsorYes
2003: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2003 form 5500 responses
2003-06-01Type of plan entitySingle employer plan
2003-06-01This submission is the final filingNo
2003-06-01Plan funding arrangement – InsuranceYes
2003-06-01Plan funding arrangement – General assets of the sponsorYes
2003-06-01Plan benefit arrangement – InsuranceYes
2003-06-01Plan benefit arrangement – General assets of the sponsorYes
2002: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2002 form 5500 responses
2002-06-01Type of plan entitySingle employer plan
2002-06-01This submission is the final filingNo
2002-06-01Plan funding arrangement – InsuranceYes
2002-06-01Plan funding arrangement – General assets of the sponsorYes
2002-06-01Plan benefit arrangement – InsuranceYes
2002-06-01Plan benefit arrangement – General assets of the sponsorYes
2001: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2001 form 5500 responses
2001-06-01Type of plan entitySingle employer plan
2001-06-01This submission is the final filingNo
2001-06-01Plan funding arrangement – InsuranceYes
2001-06-01Plan funding arrangement – General assets of the sponsorYes
2001-06-01Plan benefit arrangement – InsuranceYes
2001-06-01Plan benefit arrangement – General assets of the sponsorYes
2000: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 2000 form 5500 responses
2000-06-01Type of plan entitySingle employer plan
2000-06-01This submission is the final filingNo
2000-06-01Plan funding arrangement – InsuranceYes
2000-06-01Plan funding arrangement – General assets of the sponsorYes
2000-06-01Plan benefit arrangement – InsuranceYes
2000-06-01Plan benefit arrangement – General assets of the sponsorYes
1999: RUSSELL SIGLER INC. HEALTH PROTECTION PLAN 1999 form 5500 responses
1999-06-01Type of plan entitySingle employer plan
1999-06-01This submission is the final filingNo
1999-06-01Plan funding arrangement – InsuranceYes
1999-06-01Plan funding arrangement – General assets of the sponsorYes
1999-06-01Plan benefit arrangement – InsuranceYes
1999-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number234872
Policy instance 5
Insurance contract or identification number234872
Number of Individuals Covered233
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $63,262
Total amount of fees paid to insurance companyUSD $0
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
Welfare Benefit Premiums Paid to CarrierUSD $1,388,659
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 number206966
Policy instance 4
Insurance contract or identification number206966
Number of Individuals Covered399
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $64,351
Total amount of fees paid to insurance companyUSD $7,011
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 providedACCIDENT,LONG TERM CARE,ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $489,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CURALINC HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract numberN/A
Policy instance 3
Insurance contract or identification numberN/A
Number of Individuals Covered766
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $13,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
Insurance contract or identification number12137680
Number of Individuals Covered593
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $2,024
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
Insurance contract or identification number38965
Number of Individuals Covered51
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $1,175
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $10,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number427453
Policy instance 6
Insurance contract or identification number427453
Number of Individuals Covered112
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $7,063
Total amount of fees paid to insurance companyUSD $1,049
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $47,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number427453
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number206966
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number234872
Policy instance 5
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number427453
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number206966
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number234872
Policy instance 5
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number427453
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number206966
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057
Policy instance 4
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number427453
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 2
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number206966
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number206966
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057/206966
Policy instance 2
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number38965
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057/206966
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057/206966
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number128111
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number128111
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057
Policy instance 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number128111
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number144057
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12137680
Policy instance 1

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