Civic Intelligence
Filing

Hbma Ee Health and Welfare Plan

Hanson Building Materials America • EIN 22-3473702 • Plan year 2001

Company ProfileSource Archive
Filing Insights

Participants

Down

15,454 → 11,779

-3,675 • -23.78%

Assets

No comparison

- → -

No earlier value available.

Investment Management Fee

-

Admin expenses - • Total expenses -

Filing Details

Context

No event flags were generated for this filing.

Status Flags

Fidelity bond in place

Not reported

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

Not reported

Leases in default

Not reported

Reportable party-in-interest issues

Not reported

Loss discovered during year

Not reported

Assets with undetermined value

Not reported

Non-cash contributions

Not reported

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

Not reported

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

Not reported

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
2002710,586$927,403,138$19,363,754$1,829iApproximate average salary by contribution assumption: employee only about $45,730 at 4% or $30,486 at 6%; with 50% employer match about $30,486 at 4% or $20,324 at 6%; with 100% employer match about $22,865 at 4% or $15,243 at 6%.
Defined Benefit Master Trust-7,974$715,091,968--
HANSON BUILDING MATERIALS AMERICA RETIREMENT SAVINGS & INVESTMENT PLAN-10,586$203,467,772$18,907,263$1,786iApproximate average salary by contribution assumption: employee only about $44,652 at 4% or $29,768 at 6%; with 50% employer match about $29,768 at 4% or $19,845 at 6%; with 100% employer match about $22,326 at 4% or $14,884 at 6%.
HBMA UNION, NE REGION-166$5,941,550--
HANSON BUILDING MATERIALS AMERICA RETIREMENT SAVINGS & INVESTMENT PLAN FOR COLLECTIVELY BARGAINED EMPLOYEES-373$2,901,848$384,870$1,032iApproximate average salary by contribution assumption: employee only about $25,796 at 4% or $17,197 at 6%; with 50% employer match about $17,197 at 4% or $11,465 at 6%; with 100% employer match about $12,898 at 4% or $8,599 at 6%.
BASIC CONSTRUCTION MATERIALS HOURLY 401K PLAN-0-$21,502-
HIGHLAND/PLUM RUN CONSTRUCTION HOURLY 401K PLAN-0-$50,119-
Hbma Ee Health and Welfare Plan-10,332---
2001711,779$234,126,824$21,022,027$1,785iApproximate average salary by contribution assumption: employee only about $44,618 at 4% or $29,745 at 6%; with 50% employer match about $29,745 at 4% or $19,830 at 6%; with 100% employer match about $22,309 at 4% or $14,873 at 6%.
HANSON BUILDING MATERIALS AMERIC RETIREMENT SAVINGS & INVESTMENT PLAN-5,214$225,065,761$20,591,299$3,949iApproximate average salary by contribution assumption: employee only about $98,731 at 4% or $65,821 at 6%; with 50% employer match about $65,821 at 4% or $43,880 at 6%; with 100% employer match about $49,365 at 4% or $32,910 at 6%.
Hbma Union, Mw & Se Regions-68$7,093,061$150,000$2,206iApproximate average salary by contribution assumption: employee only about $55,147 at 4% or $36,765 at 6%; with 50% employer match about $36,765 at 4% or $24,510 at 6%; with 100% employer match about $27,574 at 4% or $18,382 at 6%.
RETIREMENT SAVINGS & INVESTMENT PLAN - COLLECTIVEL BARGAINING-221$1,968,002$280,728$1,270iApproximate average salary by contribution assumption: employee only about $31,757 at 4% or $21,171 at 6%; with 50% employer match about $21,171 at 4% or $14,114 at 6%; with 100% employer match about $15,878 at 4% or $10,586 at 6%.
HIGHLAND/PLUM RUN CONSTRUCTION HOURLY 401K PLAN-93---
BASIC CONSTRUCTION MATERIALS HOURLY 401K PLAN-64---
Hbma Ee Health and Welfare PlanCurrent11,779---
HBMA UNION, NE REGION-166---
2000515,454$2,396,605$0-
Hbma Union, Mw & Se Regions-72$2,396,605--
Hbma Ee Health and Welfare Plan-15,454---
HANSON BUILDING MATERIALS AMERIC RETIREMENT SAVINGS & INVESTMENT PLAN-4,499---
Defined Benefit Master Trust-4,859---
HBMA UNION, NE REGION-168---
1999513,794$855,639,805$1,343,035$97iApproximate average salary by contribution assumption: employee only about $2,434 at 4% or $1,623 at 6%; with 50% employer match about $1,623 at 4% or $1,082 at 6%; with 100% employer match about $1,217 at 4% or $811 at 6%.
Defined Benefit Master Trust-4,896$848,657,763$902,967$184iApproximate average salary by contribution assumption: employee only about $4,611 at 4% or $3,074 at 6%; with 50% employer match about $3,074 at 4% or $2,049 at 6%; with 100% employer match about $2,305 at 4% or $1,537 at 6%.
Hanson B M a Corporate Retirement Savings and Investment Plan-35$4,403,035$440,068$12,573iApproximate average salary by contribution assumption: employee only about $314,334 at 4% or $209,556 at 6%; with 50% employer match about $209,556 at 4% or $139,704 at 6%; with 100% employer match about $157,167 at 4% or $104,778 at 6%.
Hbma Union, Mw & Se Regions-109$2,579,007--
Hbma Ee Health and Welfare Plan-13,794---
Defined Benefit Master Trust-4,925---
Schedule Details

Schedule A

Row 1
Filing Id
84037251231024
Form Id
50693709
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020013
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 2
Filing Id
84037251231024
Form Id
50693708
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020012
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 3
Filing Id
84037251231024
Form Id
50693698
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020002
Ins Broker 01 Name
WILLIS CORROON LIFE
Ins Broker 01 Street Addr
301 COMMERCE ST STE 3050
Ins Broker 01 City
FT WORTH
Ins Broker 01 State
TX
Ins Broker 01 ZIP Code
76102
Ins Broker Comm Pd 01 Amount
$51,344
Ins Broker Fees Pd 01 Amount
$0
Row 4
Filing Id
84037251231024
Form Id
50693700
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020004
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 5
Filing Id
84037251231024
Form Id
50693702
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020006
Ins Broker 01 Name
WILLIS CORROON LIFE INS
Ins Broker 01 Street Addr
P O BOX 73075
Ins Broker 01 City
DALLAS
Ins Broker 01 State
TX
Ins Broker 01 ZIP Code
75373
Ins Broker Comm Pd 01 Amount
$133,584
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 6
Filing Id
84037251231024
Form Id
50693703
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020007
Ins Broker 01 Name
WILLIS CORROON LIFE
Ins Broker 01 Street Addr
PO BOX 730175
Ins Broker 01 City
DALLAS
Ins Broker 01 State
TX
Ins Broker 01 ZIP Code
75373
Ins Broker Comm Pd 01 Amount
$51,063
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 7
Filing Id
84037251231024
Form Id
50693706
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020010
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 8
Filing Id
84037251231024
Form Id
50693707
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020011
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 9
Filing Id
84037251231024
Form Id
50693699
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020003
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 10
Filing Id
84037251231024
Form Id
50693701
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020005
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 11
Filing Id
84037251231024
Form Id
50693705
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020009
Ins Broker 01 Name
JOHN RYAN
Ins Broker 01 Street Addr
PO BOX 885
Ins Broker 01 City
FT WAYNE
Ins Broker 01 State
IN
Ins Broker 01 ZIP Code
46801
Ins Broker Comm Pd 01 Amount
$100
Ins Broker Fees Pd 01 Amount
$0
Row 12
Filing Id
84037251231024
Form Id
50693710
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020014
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 13
Filing Id
84037251231024
Form Id
50693711
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020015
Ins Broker 01 Name
WILLIS CORROON LIFE INS
Ins Broker Comm Pd 01 Amount
$25,675
Ins Broker Fees Pd 01 Amount
$0
Row 14
Filing Id
84037251231024
Form Id
50693712
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020016
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 15
Filing Id
84037251231024
Form Id
50693704
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020008
Ins Broker 01 Name
WILLIS TEXAS
Ins Broker 01 Street Addr
9300 LBJ FREEWAY, STE 1300
Ins Broker 01 City
DALLAS
Ins Broker 01 State
TX
Ins Broker 01 ZIP Code
75243
Ins Broker Comm Pd 01 Amount
$51,610
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 16
Filing Id
84037251231024
Form Id
50693713
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
1010374251231020017
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 17
Ins Carrier Name: ZURICH
Filing Id
84037251231024
Form Id
50693704
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
ZURICH
Ins Carrier EIN
36-4233459
Ins Carrier Naic Code
16535
Ins Contract Num
GTU3586807
Ins Prsn Covered End of year Count
7,233
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$51,610
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
AD&D
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$516,108
Wlfr Acquis Cost Amount
$0
Row 18
Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN
Filing Id
84037251231024
Form Id
50693709
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
KAISER FOUNDATION HEALTH PLAN
Ins Carrier EIN
94-1340523
Ins Carrier Naic Code
60053
Ins Contract Num
2500110
Ins Prsn Covered End of year Count
25
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$35,286
Wlfr Acquis Cost Amount
$0
Row 19
Ins Carrier Name: CAREFIRST OF MARYLAND INC
Filing Id
84037251231024
Form Id
50693706
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
CAREFIRST OF MARYLAND INC
Ins Carrier EIN
52-1385894
Ins Carrier Naic Code
47058
Ins Contract Num
08099
Ins Prsn Covered End of year Count
605
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
A
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$993,866
Wlfr Acquis Cost Amount
$0
Row 20
Ins Carrier Name: UNITED HEALTHCARE
Filing Id
84037251231024
Form Id
50693699
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
UNITED HEALTHCARE
Ins Carrier EIN
36-2739571
Ins Contract Num
209405
Ins Prsn Covered End of year Count
10,137
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$730,342
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$730,342
Wlfr Claims Paid Amount
$43,254
Wlfr Incr Reserve Amount
$7,487
Wlfr Incurred Claim Amount
$50,741
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$3,022
Wlfr Ret Charges Amount
$3,380
Wlfr Ret Oth Chrgs Amount
$15,270
Wlfr Ret Total Amount
$21,672
Wlfr Refund Indicator
No
Wlfr Refund Amount
$48,447
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$730,342
Wlfr Acquis Cost Amount
$0
Row 21
Ins Carrier Name: BC BS OF HIGHMARK
Filing Id
84037251231024
Form Id
50693700
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
BC BS OF HIGHMARK
Ins Contract Num
46267
Ins Prsn Covered End of year Count
571
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AD
Wlfr Premium Rcvd Amount
$2,428,377
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$2,428,377
Wlfr Claims Paid Amount
$2,183,580
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$2,183,580
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$244,797
Wlfr Ret Total Amount
$244,797
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 22
Ins Carrier Name: BS BC OF HIGHMARK
Filing Id
84037251231024
Form Id
50693701
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
BS BC OF HIGHMARK
Ins Contract Num
4932601/02
Ins Prsn Covered End of year Count
2
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$4,223
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$4,223
Wlfr Claims Paid Amount
$3,282
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$3,282
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$942
Wlfr Ret Total Amount
$942
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 23
Ins Carrier Name: PROVIDENT LIFE INS
Filing Id
84037251231024
Form Id
50693702
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
PROVIDENT LIFE INS
Ins Carrier EIN
62-0331200
Ins Carrier Naic Code
68195
Ins Contract Num
123653
Ins Prsn Covered End of year Count
16,134
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$133,584
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
DF
Wlfr Premium Rcvd Amount
$833,659
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$833,659
Wlfr Claims Paid Amount
$805,102
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$805,102
Wlfr Claims Chrgd Amount
$805,102
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$28,557
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$28,557
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$4,452,796
Wlfr Acquis Cost Amount
$0
Row 24
Ins Carrier Name: PROVIDENT LIFE & ACCIDENT INS CO
Filing Id
84037251231024
Form Id
50693703
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
PROVIDENT LIFE & ACCIDENT INS CO
Ins Carrier EIN
62-0331200
Ins Carrier Naic Code
68195
Ins Contract Num
123235
Ins Prsn Covered End of year Count
4,001
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$51,063
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
E
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$510,629
Wlfr Acquis Cost Amount
$0
Row 25
Ins Carrier Name: LINCOLN NATIONA LIFE INSURANCE
Filing Id
84037251231024
Form Id
50693705
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
LINCOLN NATIONA LIFE INSURANCE
Ins Carrier EIN
35-0472300
Ins Carrier Naic Code
65676
Ins Contract Num
GP48465
Ins Prsn Covered End of year Count
153
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$100
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
D
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$766
Wlfr Acquis Cost Amount
$0
Row 26
Ins Carrier Name: PACIFICARE OF CALIFORNIA
Filing Id
84037251231024
Form Id
50693710
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
PACIFICARE OF CALIFORNIA
Ins Carrier EIN
95-2931460
Ins Carrier Naic Code
70785
Ins Contract Num
510492
Ins Prsn Covered End of year Count
25
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$16,888
Wlfr Acquis Cost Amount
$0
Row 27
Ins Carrier Name: CONNECTICUT GENERAL LIFE INS
Filing Id
84037251231024
Form Id
50693711
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
CONNECTICUT GENERAL LIFE INS
Ins Carrier EIN
06-0303370
Ins Carrier Naic Code
62308
Ins Contract Num
2373970
Ins Prsn Covered End of year Count
7,085
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$25,675
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
B
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$1,078,665
Wlfr Acquis Cost Amount
$233,711
Wlfr Acquis Cost Text
ASO SERVICE FEES PAID BY CUSTOMER TO CONN GENL LIFE I NSURANCE CO
Row 28
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037251231024
Form Id
50693712
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
KAISER PERMANENTE
Ins Contract Num
81980002
Ins Prsn Covered End of year Count
53
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$114,976
Wlfr Acquis Cost Amount
$0
Row 29
Ins Carrier Name: KAISER PERMAMENTE
Filing Id
84037251231024
Form Id
50693713
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
KAISER PERMAMENTE
Ins Contract Num
81980003
Ins Prsn Covered End of year Count
3
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$6,222
Wlfr Acquis Cost Amount
$0
Row 30
Ins Carrier Name: RELAISTAR LIFE INSURANCE CO/ ING
Filing Id
84037251231024
Form Id
50693698
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
RELAISTAR LIFE INSURANCE CO/ ING
Ins Carrier EIN
41-0451140
Ins Carrier Naic Code
67105
Ins Contract Num
57051
Ins Prsn Covered End of year Count
26,606
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$51,344
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$804,018
Wlfr Acquis Cost Amount
$0
Row 31
Ins Carrier Name: KAISER FOUNDAITON HEALTH PLAN
Filing Id
84037251231024
Form Id
50693708
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
KAISER FOUNDAITON HEALTH PLAN
Ins Carrier EIN
94-1340523
Ins Carrier Naic Code
60053
Ins Contract Num
2500211
Ins Prsn Covered End of year Count
43
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$41,479
Wlfr Acquis Cost Amount
$0
Row 32
Ins Carrier Name: BCBSM, INC
Filing Id
84037251231024
Form Id
50693707
Schedule A EIN
22-3473702
Schedule A Plan Num
524
Schedule A Plan Year Begin Date
2001-01-01
Schedule A Tax Period
20011231
Ins Carrier Name
BCBSM, INC
Ins Carrier EIN
41-0984460
Ins Carrier Naic Code
55026
Ins Contract Num
CS460
Ins Prsn Covered End of year Count
373
Ins Policy From Date
2001-01-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
A
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$79,427
Wlfr Acquis Cost Amount
$0