SKY LAKES MEDICAL CENTER has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: SKY LAKES MEDICAL CENTER 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,231 |
| Total of all active and inactive participants | 2022-01-01 | 1,231 |
| 2021: SKY LAKES MEDICAL CENTER 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,200 |
| Total of all active and inactive participants | 2021-01-01 | 1,200 |
| 2020: SKY LAKES MEDICAL CENTER 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,210 |
| Total of all active and inactive participants | 2020-01-01 | 1,210 |
| 2019: SKY LAKES MEDICAL CENTER 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,252 |
| Total of all active and inactive participants | 2019-01-01 | 1,252 |
| 2018: SKY LAKES MEDICAL CENTER 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,189 |
| Total of all active and inactive participants | 2018-01-01 | 1,189 |
| 2017: SKY LAKES MEDICAL CENTER 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,179 |
| Total of all active and inactive participants | 2017-01-01 | 1,179 |
| 2016: SKY LAKES MEDICAL CENTER 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,071 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,146 |
| Total of all active and inactive participants | 2016-01-01 | 1,146 |
| 2015: SKY LAKES MEDICAL CENTER 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,018 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,071 |
| Total of all active and inactive participants | 2015-01-01 | 1,071 |
| 2014: SKY LAKES MEDICAL CENTER 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,179 |
| Total of all active and inactive participants | 2014-01-01 | 1,179 |
| 2013: SKY LAKES MEDICAL CENTER 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 918 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 975 |
| Total of all active and inactive participants | 2013-01-01 | 975 |
| 2012: SKY LAKES MEDICAL CENTER 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 896 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 918 |
| Total of all active and inactive participants | 2012-01-01 | 918 |
| 2011: SKY LAKES MEDICAL CENTER 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 901 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 896 |
| Total of all active and inactive participants | 2011-01-01 | 896 |
| 2010: SKY LAKES MEDICAL CENTER 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 905 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 901 |
| Total of all active and inactive participants | 2010-01-01 | 901 |
| 2009: SKY LAKES MEDICAL CENTER 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 985 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 905 |
| Total of all active and inactive participants | 2009-01-01 | 905 |
| 2022: SKY LAKES MEDICAL CENTER 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SKY LAKES MEDICAL CENTER 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: SKY LAKES MEDICAL CENTER 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: SKY LAKES MEDICAL CENTER 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SKY LAKES MEDICAL CENTER 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SKY LAKES MEDICAL CENTER 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SKY LAKES MEDICAL CENTER 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: SKY LAKES MEDICAL CENTER 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SKY LAKES MEDICAL CENTER 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SKY LAKES MEDICAL CENTER 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: SKY LAKES MEDICAL CENTER 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: SKY LAKES MEDICAL CENTER 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: SKY LAKES MEDICAL CENTER 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SKY LAKES MEDICAL CENTER 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 672950 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR 672950 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $234 | | Total amount of fees paid to insurance company | USD $550 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $234 | | Amount paid for insurance broker fees | 550 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1189 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,848 | | Total amount of fees paid to insurance company | USD $23,452 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $196,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,848 | | Amount paid for insurance broker fees | 23452 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1213 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,542 | | Total amount of fees paid to insurance company | USD $23,037 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $190,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,542 | | Amount paid for insurance broker fees | 23037 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 672950 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR 672950 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $216 | | Total amount of fees paid to insurance company | USD $521 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $216 | | Amount paid for insurance broker fees | 521 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1245 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,768 | | Total amount of fees paid to insurance company | USD $22,861 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $195,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,768 | | Amount paid for insurance broker fees | 22861 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 672950 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR 672950 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $222 | | Total amount of fees paid to insurance company | USD $524 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $222 | | Amount paid for insurance broker fees | 524 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 672950 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR 672950 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $208 | | Total amount of fees paid to insurance company | USD $509 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $208 | | Amount paid for insurance broker fees | 509 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1193 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,799 | | Total amount of fees paid to insurance company | USD $21,610 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $175,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,799 | | Amount paid for insurance broker fees | 21610 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 672950 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR 672950 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $224 | | Total amount of fees paid to insurance company | USD $503 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $224 | | Amount paid for insurance broker fees | 503 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1172 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,620 | | Total amount of fees paid to insurance company | USD $21,056 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $192,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,620 | | Amount paid for insurance broker fees | 21056 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1139 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $8,309 | | Total amount of fees paid to insurance company | USD $18,133 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $166,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,309 | | Amount paid for insurance broker fees | 18133 | | Additional information about fees paid to insurance broker | ADMINISTRATION AND OTHER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICE INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 668975 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 668975 | | Number of Individuals Covered | 1018 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,544 | | Total amount of fees paid to insurance company | USD $11,780 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $130,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,544 | | Amount paid for insurance broker fees | 11780 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICE INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965274 |
| Policy instance | 2 |
| Insurance contract or identification number | OK 965274 | | Number of Individuals Covered | 1032 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,692 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $15,509 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,692 | | Additional information about fees paid to insurance broker | SUPP. COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963642 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX963642 | | Number of Individuals Covered | 1179 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $16,672 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $116,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,672 | | Additional information about fees paid to insurance broker | SUPP COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963642 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX963642 | | Number of Individuals Covered | 975 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $16,058 | | Total amount of fees paid to insurance company | USD $-269 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $110,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,058 | | Amount paid for insurance broker fees | -269 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965274 |
| Policy instance | 2 |
| Insurance contract or identification number | OK 965274 | | Number of Individuals Covered | 975 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,577 | | Total amount of fees paid to insurance company | USD $-35 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $14,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,577 | | Amount paid for insurance broker fees | -35 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963642 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX963642 | | Number of Individuals Covered | 918 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,056 | | Total amount of fees paid to insurance company | USD $269 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE DEPENDENT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $105,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,056 | | Amount paid for insurance broker fees | 269 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965271 |
| Policy instance | 2 |
| Insurance contract or identification number | OK 965271 | | Number of Individuals Covered | 918 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,477 | | Total amount of fees paid to insurance company | USD $35 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,477 | | Amount paid for insurance broker fees | 35 | | Additional information about fees paid to insurance broker | SUPP COMMISSION & OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX 963642 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX 963642 | | Number of Individuals Covered | 896 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $13,550 | | Total amount of fees paid to insurance company | USD $1,202 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965274 |
| Policy instance | 2 |
| Insurance contract or identification number | OK 965274 | | Number of Individuals Covered | 896 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,380 | | Total amount of fees paid to insurance company | USD $172 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 965274 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 965274 | | Number of Individuals Covered | 901 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $341 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $341 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX 963642 |
| Policy instance | 2 |
| Insurance contract or identification number | FLX 963642 | | Number of Individuals Covered | 901 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,076 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,076 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WTB 000267 |
| Policy instance | 1 |
| Insurance contract or identification number | WTB 000267 | | Number of Individuals Covered | 884 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $7,705 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,705 | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
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