Fidelity bond in place
Not reported
Filing
Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan
Contech Engineered Solutions LLC • EIN 31-1177165 • Plan year 1999
Filing Insights
Participants
Down1,054 → 959
-95 • -9.01%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
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 / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2024 | 3 | 30 | $2,358,492 | $56,799 | $1,893iApproximate average salary by contribution assumption: employee only about $47,333 at 4% or $31,555 at 6%; with 50% employer match about $31,555 at 4% or $21,037 at 6%; with 100% employer match about $23,666 at 4% or $15,778 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 30 | $1,165,232 | $0 | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 13 | $835,591 | $40,947 | $3,150iApproximate average salary by contribution assumption: employee only about $78,744 at 4% or $52,496 at 6%; with 50% employer match about $52,496 at 4% or $34,997 at 6%; with 100% employer match about $39,372 at 4% or $26,248 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 7 | $357,669 | $15,852 | $2,265iApproximate average salary by contribution assumption: employee only about $56,614 at 4% or $37,743 at 6%; with 50% employer match about $37,743 at 4% or $25,162 at 6%; with 100% employer match about $28,307 at 4% or $18,871 at 6%. |
| 2023 | 3 | 30 | $2,221,323 | $60,881 | $2,029iApproximate average salary by contribution assumption: employee only about $50,734 at 4% or $33,823 at 6%; with 50% employer match about $33,823 at 4% or $22,549 at 6%; with 100% employer match about $25,367 at 4% or $16,911 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 30 | $1,169,034 | $0 | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 16 | $745,519 | $45,606 | $2,850iApproximate average salary by contribution assumption: employee only about $71,259 at 4% or $47,506 at 6%; with 50% employer match about $47,506 at 4% or $31,671 at 6%; with 100% employer match about $35,630 at 4% or $23,753 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 9 | $306,770 | $15,275 | $1,697iApproximate average salary by contribution assumption: employee only about $42,431 at 4% or $28,287 at 6%; with 50% employer match about $28,287 at 4% or $18,858 at 6%; with 100% employer match about $21,215 at 4% or $14,144 at 6%. |
| 2022 | 3 | 31 | $2,047,128 | $67,965 | $2,192iApproximate average salary by contribution assumption: employee only about $54,810 at 4% or $36,540 at 6%; with 50% employer match about $36,540 at 4% or $24,360 at 6%; with 100% employer match about $27,405 at 4% or $18,270 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 31 | $1,208,161 | $0 | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 15 | $590,410 | $53,746 | $3,583iApproximate average salary by contribution assumption: employee only about $89,577 at 4% or $59,718 at 6%; with 50% employer match about $59,718 at 4% or $39,812 at 6%; with 100% employer match about $44,788 at 4% or $29,859 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 7 | $248,557 | $14,219 | $2,031iApproximate average salary by contribution assumption: employee only about $50,782 at 4% or $33,855 at 6%; with 50% employer match about $33,855 at 4% or $22,570 at 6%; with 100% employer match about $25,391 at 4% or $16,927 at 6%. |
| 2021 | 3 | 31 | $2,248,799 | $62,626 | $2,020iApproximate average salary by contribution assumption: employee only about $50,505 at 4% or $33,670 at 6%; with 50% employer match about $33,670 at 4% or $22,447 at 6%; with 100% employer match about $25,252 at 4% or $16,835 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 31 | $1,282,187 | $0 | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 14 | $683,681 | $48,151 | $3,439iApproximate average salary by contribution assumption: employee only about $85,984 at 4% or $57,323 at 6%; with 50% employer match about $57,323 at 4% or $38,215 at 6%; with 100% employer match about $42,992 at 4% or $28,661 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 8 | $282,931 | $14,475 | $1,809iApproximate average salary by contribution assumption: employee only about $45,234 at 4% or $30,156 at 6%; with 50% employer match about $30,156 at 4% or $20,104 at 6%; with 100% employer match about $22,617 at 4% or $15,078 at 6%. |
| 2020 | 3 | 35 | $2,528,901 | $118,180 | $3,377iApproximate average salary by contribution assumption: employee only about $84,414 at 4% or $56,276 at 6%; with 50% employer match about $56,276 at 4% or $37,517 at 6%; with 100% employer match about $42,207 at 4% or $28,138 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 35 | $1,589,545 | $63,000 | $1,800iApproximate average salary by contribution assumption: employee only about $45,000 at 4% or $30,000 at 6%; with 50% employer match about $30,000 at 4% or $20,000 at 6%; with 100% employer match about $22,500 at 4% or $15,000 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 15 | $703,322 | $42,377 | $2,825iApproximate average salary by contribution assumption: employee only about $70,628 at 4% or $47,086 at 6%; with 50% employer match about $47,086 at 4% or $31,390 at 6%; with 100% employer match about $35,314 at 4% or $23,543 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 7 | $236,034 | $12,803 | $1,829iApproximate average salary by contribution assumption: employee only about $45,725 at 4% or $30,483 at 6%; with 50% employer match about $30,483 at 4% or $20,322 at 6%; with 100% employer match about $22,863 at 4% or $15,242 at 6%. |
| 2019 | 3 | 40 | $2,101,194 | $164,385 | $4,110iApproximate average salary by contribution assumption: employee only about $102,741 at 4% or $68,494 at 6%; with 50% employer match about $68,494 at 4% or $45,663 at 6%; with 100% employer match about $51,370 at 4% or $34,247 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 40 | $1,340,198 | $108,000 | $2,700iApproximate average salary by contribution assumption: employee only about $67,500 at 4% or $45,000 at 6%; with 50% employer match about $45,000 at 4% or $30,000 at 6%; with 100% employer match about $33,750 at 4% or $22,500 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 15 | $570,578 | $43,298 | $2,887iApproximate average salary by contribution assumption: employee only about $72,163 at 4% or $48,109 at 6%; with 50% employer match about $48,109 at 4% or $32,073 at 6%; with 100% employer match about $36,082 at 4% or $24,054 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 8 | $190,418 | $13,087 | $1,636iApproximate average salary by contribution assumption: employee only about $40,897 at 4% or $27,265 at 6%; with 50% employer match about $27,265 at 4% or $18,176 at 6%; with 100% employer match about $20,448 at 4% or $13,632 at 6%. |
| 2018 | 5 | 42 | $1,859,945 | $121,880 | $2,902iApproximate average salary by contribution assumption: employee only about $72,548 at 4% or $48,365 at 6%; with 50% employer match about $48,365 at 4% or $32,243 at 6%; with 100% employer match about $36,274 at 4% or $24,183 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 42 | $1,220,413 | $75,000 | $1,786iApproximate average salary by contribution assumption: employee only about $44,643 at 4% or $29,762 at 6%; with 50% employer match about $29,762 at 4% or $19,841 at 6%; with 100% employer match about $22,321 at 4% or $14,881 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 12 | $495,652 | $33,449 | $2,787iApproximate average salary by contribution assumption: employee only about $69,685 at 4% or $46,457 at 6%; with 50% employer match about $46,457 at 4% or $30,971 at 6%; with 100% employer match about $34,843 at 4% or $23,228 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 6 | $143,880 | $13,431 | $2,239iApproximate average salary by contribution assumption: employee only about $55,963 at 4% or $37,308 at 6%; with 50% employer match about $37,308 at 4% or $24,872 at 6%; with 100% employer match about $27,981 at 4% or $18,654 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 0 | - | - | - |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 0 | - | - | - |
| 2017 | 5 | 722 | $153,411,610 | $184,622 | $256iApproximate average salary by contribution assumption: employee only about $6,393 at 4% or $4,262 at 6%; with 50% employer match about $4,262 at 4% or $2,841 at 6%; with 100% employer match about $3,196 at 4% or $2,131 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 722 | $127,880,320 | - | - |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 609 | $24,325,185 | - | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 43 | $1,144,264 | $127,000 | $2,953iApproximate average salary by contribution assumption: employee only about $73,837 at 4% or $49,225 at 6%; with 50% employer match about $49,225 at 4% or $32,817 at 6%; with 100% employer match about $36,919 at 4% or $24,612 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 12 | $47,046 | $43,954 | $3,663iApproximate average salary by contribution assumption: employee only about $91,571 at 4% or $61,047 at 6%; with 50% employer match about $61,047 at 4% or $40,698 at 6%; with 100% employer match about $45,785 at 4% or $30,524 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 7 | $14,795 | $13,668 | $1,953iApproximate average salary by contribution assumption: employee only about $48,814 at 4% or $32,543 at 6%; with 50% employer match about $32,543 at 4% or $21,695 at 6%; with 100% employer match about $24,407 at 4% or $16,271 at 6%. |
| 2016 | 5 | 1,418 | $141,435,274 | $6,098,404 | $4,301iApproximate average salary by contribution assumption: employee only about $107,518 at 4% or $71,678 at 6%; with 50% employer match about $71,678 at 4% or $47,786 at 6%; with 100% employer match about $53,759 at 4% or $35,839 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 843 | $116,895,519 | $4,874,369 | $5,782iApproximate average salary by contribution assumption: employee only about $144,554 at 4% or $96,369 at 6%; with 50% employer match about $96,369 at 4% or $64,246 at 6%; with 100% employer match about $72,277 at 4% or $48,185 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 727 | $23,450,583 | $1,204,035 | $1,656iApproximate average salary by contribution assumption: employee only about $41,404 at 4% or $27,603 at 6%; with 50% employer match about $27,603 at 4% or $18,402 at 6%; with 100% employer match about $20,702 at 4% or $13,801 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 44 | $1,089,172 | $20,000 | $455iApproximate average salary by contribution assumption: employee only about $11,364 at 4% or $7,576 at 6%; with 50% employer match about $7,576 at 4% or $5,051 at 6%; with 100% employer match about $5,682 at 4% or $3,788 at 6%. |
| Flexible Spending Account | - | 194 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,418 | - | - | - |
| 2015 | 5 | 1,352 | $139,237,577 | $7,512,244 | $5,556iApproximate average salary by contribution assumption: employee only about $138,910 at 4% or $92,607 at 6%; with 50% employer match about $92,607 at 4% or $61,738 at 6%; with 100% employer match about $69,455 at 4% or $46,303 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 792 | $114,517,232 | $6,118,538 | $7,725iApproximate average salary by contribution assumption: employee only about $193,136 at 4% or $128,757 at 6%; with 50% employer match about $128,757 at 4% or $85,838 at 6%; with 100% employer match about $96,568 at 4% or $64,379 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 726 | $23,622,878 | $1,393,706 | $1,920iApproximate average salary by contribution assumption: employee only about $47,993 at 4% or $31,995 at 6%; with 50% employer match about $31,995 at 4% or $21,330 at 6%; with 100% employer match about $23,996 at 4% or $15,998 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 45 | $1,097,467 | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,352 | - | - | - |
| Flexible Spending Account | - | 230 | - | - | - |
| 2014 | 5 | 1,168 | $139,653,935 | $6,883,724 | $5,894iApproximate average salary by contribution assumption: employee only about $147,340 at 4% or $98,227 at 6%; with 50% employer match about $98,227 at 4% or $65,484 at 6%; with 100% employer match about $73,670 at 4% or $49,113 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 780 | $114,335,079 | $5,704,160 | $7,313iApproximate average salary by contribution assumption: employee only about $182,826 at 4% or $121,884 at 6%; with 50% employer match about $121,884 at 4% or $81,256 at 6%; with 100% employer match about $91,413 at 4% or $60,942 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 709 | $24,149,488 | $1,179,564 | $1,664iApproximate average salary by contribution assumption: employee only about $41,593 at 4% or $27,728 at 6%; with 50% employer match about $27,728 at 4% or $18,486 at 6%; with 100% employer match about $20,796 at 4% or $13,864 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 45 | $1,169,368 | $0 | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,168 | - | - | - |
| Flexible Spending Account | - | 208 | - | - | - |
| 2013 | 5 | 1,159 | $132,686,916 | $6,374,986 | $5,500iApproximate average salary by contribution assumption: employee only about $137,510 at 4% or $91,674 at 6%; with 50% employer match about $91,674 at 4% or $61,116 at 6%; with 100% employer match about $68,755 at 4% or $45,837 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 744 | $107,085,814 | $5,213,811 | $7,008iApproximate average salary by contribution assumption: employee only about $175,195 at 4% or $116,797 at 6%; with 50% employer match about $116,797 at 4% or $77,865 at 6%; with 100% employer match about $87,598 at 4% or $58,398 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 674 | $24,321,921 | $1,106,546 | $1,642iApproximate average salary by contribution assumption: employee only about $41,044 at 4% or $27,363 at 6%; with 50% employer match about $27,363 at 4% or $18,242 at 6%; with 100% employer match about $20,522 at 4% or $13,681 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 46 | $1,279,181 | $54,629 | $1,188iApproximate average salary by contribution assumption: employee only about $29,690 at 4% or $19,793 at 6%; with 50% employer match about $19,793 at 4% or $13,195 at 6%; with 100% employer match about $14,845 at 4% or $9,897 at 6%. |
| Flexible Spending Account | - | 259 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,159 | - | - | - |
| 2012 | 5 | 1,302 | $122,639,062 | $6,452,690 | $4,956iApproximate average salary by contribution assumption: employee only about $123,900 at 4% or $82,600 at 6%; with 50% employer match about $82,600 at 4% or $55,066 at 6%; with 100% employer match about $61,950 at 4% or $41,300 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 862 | $99,581,290 | $5,405,572 | $6,271iApproximate average salary by contribution assumption: employee only about $156,774 at 4% or $104,516 at 6%; with 50% employer match about $104,516 at 4% or $69,677 at 6%; with 100% employer match about $78,387 at 4% or $52,258 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 655 | $21,920,729 | $958,760 | $1,464iApproximate average salary by contribution assumption: employee only about $36,594 at 4% or $24,396 at 6%; with 50% employer match about $24,396 at 4% or $16,264 at 6%; with 100% employer match about $18,297 at 4% or $12,198 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 46 | $1,137,043 | $88,358 | $1,921iApproximate average salary by contribution assumption: employee only about $48,021 at 4% or $32,014 at 6%; with 50% employer match about $32,014 at 4% or $21,343 at 6%; with 100% employer match about $24,010 at 4% or $16,007 at 6%. |
| Flexible Spending Account | - | 280 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,302 | - | - | - |
| 2011 | 5 | 1,272 | $109,508,961 | $5,207,776 | $4,094iApproximate average salary by contribution assumption: employee only about $102,354 at 4% or $68,236 at 6%; with 50% employer match about $68,236 at 4% or $45,491 at 6%; with 100% employer match about $51,177 at 4% or $34,118 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 847 | $87,667,947 | $4,536,836 | $5,356iApproximate average salary by contribution assumption: employee only about $133,909 at 4% or $89,273 at 6%; with 50% employer match about $89,273 at 4% or $59,515 at 6%; with 100% employer match about $66,954 at 4% or $44,636 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 654 | $20,778,522 | $594,700 | $909iApproximate average salary by contribution assumption: employee only about $22,733 at 4% or $15,155 at 6%; with 50% employer match about $15,155 at 4% or $10,104 at 6%; with 100% employer match about $11,367 at 4% or $7,578 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 46 | $1,062,492 | $76,240 | $1,657iApproximate average salary by contribution assumption: employee only about $41,435 at 4% or $27,623 at 6%; with 50% employer match about $27,623 at 4% or $18,415 at 6%; with 100% employer match about $20,717 at 4% or $13,812 at 6%. |
| Flexible Spending Account | - | 436 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,272 | - | - | - |
| 2010 | 5 | 1,426 | $115,798,940 | $4,586,656 | $3,216iApproximate average salary by contribution assumption: employee only about $80,411 at 4% or $53,607 at 6%; with 50% employer match about $53,607 at 4% or $35,738 at 6%; with 100% employer match about $40,206 at 4% or $26,804 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 924 | $93,127,711 | $3,870,472 | $4,189iApproximate average salary by contribution assumption: employee only about $104,721 at 4% or $69,814 at 6%; with 50% employer match about $69,814 at 4% or $46,542 at 6%; with 100% employer match about $52,360 at 4% or $34,907 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 696 | $21,614,737 | $643,876 | $925iApproximate average salary by contribution assumption: employee only about $23,128 at 4% or $15,418 at 6%; with 50% employer match about $15,418 at 4% or $10,279 at 6%; with 100% employer match about $11,564 at 4% or $7,709 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 48 | $1,056,492 | $72,308 | $1,506iApproximate average salary by contribution assumption: employee only about $37,660 at 4% or $25,107 at 6%; with 50% employer match about $25,107 at 4% or $16,738 at 6%; with 100% employer match about $18,830 at 4% or $12,553 at 6%. |
| Flexible Spending Account | - | 402 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,426 | - | - | - |
| 2009 | 5 | 1,336 | $107,532,255 | $2,483,536 | $1,859iApproximate average salary by contribution assumption: employee only about $46,473 at 4% or $30,982 at 6%; with 50% employer match about $30,982 at 4% or $20,655 at 6%; with 100% employer match about $23,237 at 4% or $15,491 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 927 | $85,850,253 | $2,098,113 | $2,263iApproximate average salary by contribution assumption: employee only about $56,583 at 4% or $37,722 at 6%; with 50% employer match about $37,722 at 4% or $25,148 at 6%; with 100% employer match about $28,292 at 4% or $18,861 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 709 | $20,732,407 | $314,024 | $443iApproximate average salary by contribution assumption: employee only about $11,073 at 4% or $7,382 at 6%; with 50% employer match about $7,382 at 4% or $4,921 at 6%; with 100% employer match about $5,536 at 4% or $3,691 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 49 | $949,595 | $71,399 | $1,457iApproximate average salary by contribution assumption: employee only about $36,428 at 4% or $24,285 at 6%; with 50% employer match about $24,285 at 4% or $16,190 at 6%; with 100% employer match about $18,214 at 4% or $12,143 at 6%. |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,336 | - | - | - |
| Flexible Spending Account | - | 479 | - | - | - |
| 2008 | 7 | 1,333 | $92,906,547 | $5,381,757 | $4,037iApproximate average salary by contribution assumption: employee only about $100,933 at 4% or $67,289 at 6%; with 50% employer match about $67,289 at 4% or $44,859 at 6%; with 100% employer match about $50,467 at 4% or $33,644 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 920 | $74,901,680 | $4,708,812 | $5,118iApproximate average salary by contribution assumption: employee only about $127,957 at 4% or $85,305 at 6%; with 50% employer match about $85,305 at 4% or $56,870 at 6%; with 100% employer match about $63,978 at 4% or $42,652 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 698 | $18,004,867 | $671,354 | $962iApproximate average salary by contribution assumption: employee only about $24,046 at 4% or $16,030 at 6%; with 50% employer match about $16,030 at 4% or $10,687 at 6%; with 100% employer match about $12,023 at 4% or $8,015 at 6%. |
| Contech Construction Products Inc. Retirement Savings Plan | - | 0 | - | - | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 0 | - | $1,591 | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 0 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,333 | - | - | - |
| Flexible Spending Account | - | 601 | - | - | - |
| 2007 | 7 | 1,623 | $0 | $0 | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 0 | - | - | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 979 | - | - | - |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 684 | - | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 36 | - | - | - |
| Ccpi Salaried Savings Plus Plan | - | 1,179 | - | - | - |
| Flexible Spending Account | - | 414 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,623 | - | - | - |
| 2006 | 7 | 1,213 | $14,347,980 | $1,241,505 | $1,023iApproximate average salary by contribution assumption: employee only about $25,587 at 4% or $17,058 at 6%; with 50% employer match about $17,058 at 4% or $11,372 at 6%; with 100% employer match about $12,794 at 4% or $8,529 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 666 | $12,454,278 | $1,127,042 | $1,692iApproximate average salary by contribution assumption: employee only about $42,306 at 4% or $28,204 at 6%; with 50% employer match about $28,204 at 4% or $18,803 at 6%; with 100% employer match about $21,153 at 4% or $14,102 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 0 | $1,352,164 | $66,285 | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 37 | $541,538 | $48,178 | $1,302iApproximate average salary by contribution assumption: employee only about $32,553 at 4% or $21,702 at 6%; with 50% employer match about $21,702 at 4% or $14,468 at 6%; with 100% employer match about $16,276 at 4% or $10,851 at 6%. |
| Flexible Spending Account | - | 170 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,094 | - | - | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 955 | - | - | - |
| Ccpi Salaried Savings Plus Plan | - | 1,213 | - | - | - |
| 2005 | 7 | 1,039 | $41,711,074 | $3,617,663 | $3,482iApproximate average salary by contribution assumption: employee only about $87,047 at 4% or $58,031 at 6%; with 50% employer match about $58,031 at 4% or $38,687 at 6%; with 100% employer match about $43,523 at 4% or $29,016 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 906 | $31,966,779 | $2,481,056 | $2,738iApproximate average salary by contribution assumption: employee only about $68,462 at 4% or $45,641 at 6%; with 50% employer match about $45,641 at 4% or $30,427 at 6%; with 100% employer match about $34,231 at 4% or $22,821 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 381 | $8,060,948 | $1,011,686 | $2,655iApproximate average salary by contribution assumption: employee only about $66,384 at 4% or $44,256 at 6%; with 50% employer match about $44,256 at 4% or $29,504 at 6%; with 100% employer match about $33,192 at 4% or $22,128 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 0 | $1,260,740 | $76,746 | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 36 | $422,607 | $48,175 | $1,338iApproximate average salary by contribution assumption: employee only about $33,455 at 4% or $22,303 at 6%; with 50% employer match about $22,303 at 4% or $14,869 at 6%; with 100% employer match about $16,727 at 4% or $11,152 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 750 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,039 | - | - | - |
| Flexible Spending Account | - | 186 | - | - | - |
| 2004 | 8 | 1,052 | $91,009,078 | $7,884,290 | $7,495iApproximate average salary by contribution assumption: employee only about $187,364 at 4% or $124,910 at 6%; with 50% employer match about $124,910 at 4% or $83,273 at 6%; with 100% employer match about $93,682 at 4% or $62,455 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 606 | $52,000,096 | $4,231,575 | $6,983iApproximate average salary by contribution assumption: employee only about $174,570 at 4% or $116,380 at 6%; with 50% employer match about $116,380 at 4% or $77,587 at 6%; with 100% employer match about $87,285 at 4% or $58,190 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 908 | $29,327,372 | $2,534,185 | $2,791iApproximate average salary by contribution assumption: employee only about $69,774 at 4% or $46,516 at 6%; with 50% employer match about $46,516 at 4% or $31,011 at 6%; with 100% employer match about $34,887 at 4% or $23,258 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 417 | $7,069,410 | $970,896 | $2,328iApproximate average salary by contribution assumption: employee only about $58,207 at 4% or $38,805 at 6%; with 50% employer match about $38,805 at 4% or $25,870 at 6%; with 100% employer match about $29,104 at 4% or $19,402 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 1 | $1,233,051 | $94,104 | $94,104iApproximate average salary by contribution assumption: employee only about $2,352,600 at 4% or $1,568,400 at 6%; with 50% employer match about $1,568,400 at 4% or $1,045,600 at 6%; with 100% employer match about $1,176,300 at 4% or $784,200 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 21 | $995,783 | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 33 | $383,366 | $53,530 | $1,622iApproximate average salary by contribution assumption: employee only about $40,553 at 4% or $27,035 at 6%; with 50% employer match about $27,035 at 4% or $18,024 at 6%; with 100% employer match about $20,277 at 4% or $13,518 at 6%. |
| Flexible Spending Account | - | 170 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 1,052 | - | - | - |
| 2003 | 8 | 980 | $78,791,596 | $6,848,612 | $6,988iApproximate average salary by contribution assumption: employee only about $174,709 at 4% or $116,473 at 6%; with 50% employer match about $116,473 at 4% or $77,649 at 6%; with 100% employer match about $87,355 at 4% or $58,236 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 496 | $45,579,694 | $3,567,480 | $7,193iApproximate average salary by contribution assumption: employee only about $179,813 at 4% or $119,875 at 6%; with 50% employer match about $119,875 at 4% or $79,917 at 6%; with 100% employer match about $89,906 at 4% or $59,938 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 816 | $26,594,211 | $2,359,500 | $2,892iApproximate average salary by contribution assumption: employee only about $72,289 at 4% or $48,192 at 6%; with 50% employer match about $48,192 at 4% or $32,128 at 6%; with 100% employer match about $36,144 at 4% or $24,096 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 404 | $6,617,691 | $921,632 | $2,281iApproximate average salary by contribution assumption: employee only about $57,032 at 4% or $38,021 at 6%; with 50% employer match about $38,021 at 4% or $25,347 at 6%; with 100% employer match about $28,516 at 4% or $19,011 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 2 | - | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 36 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 980 | - | - | - |
| Contech Construction Products Inc Group Long Term Disability Plan | - | 772 | - | - | - |
| Contech Construction Products Inc. Short Term Disability Plan | - | 448 | - | - | - |
| 2002 | 9 | 933 | $0 | $0 | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 3 | - | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 37 | - | - | - |
| Flexible Spending Account | - | 105 | - | - | - |
| Contech Construction Products Inc. Short Term Disability Plan | - | 425 | - | - | - |
| Contech Construction Products Inc Group Long Term Disability Plan | - | 726 | - | - | - |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 418 | - | - | - |
| Contech Construction Products Inc. Profit Sharing Plan | - | 844 | - | - | - |
| Ccpi Salaried Savings Plus Plan | - | 473 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 933 | - | - | - |
| 2001 | 8 | 962 | $60,767,429 | $5,822,035 | $6,052iApproximate average salary by contribution assumption: employee only about $151,300 at 4% or $100,867 at 6%; with 50% employer match about $100,867 at 4% or $67,245 at 6%; with 100% employer match about $75,650 at 4% or $50,433 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 450 | $35,294,293 | $3,215,697 | $7,146iApproximate average salary by contribution assumption: employee only about $178,650 at 4% or $119,100 at 6%; with 50% employer match about $119,100 at 4% or $79,400 at 6%; with 100% employer match about $89,325 at 4% or $59,550 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 880 | $20,750,556 | $1,741,420 | $1,979iApproximate average salary by contribution assumption: employee only about $49,472 at 4% or $32,981 at 6%; with 50% employer match about $32,981 at 4% or $21,988 at 6%; with 100% employer match about $24,736 at 4% or $16,491 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 404 | $4,722,580 | $864,918 | $2,141iApproximate average salary by contribution assumption: employee only about $53,522 at 4% or $35,681 at 6%; with 50% employer match about $35,681 at 4% or $23,788 at 6%; with 100% employer match about $26,761 at 4% or $17,841 at 6%. |
| Contech Construction Products Inc Group Long Term Disability Plan | - | 747 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 962 | - | - | - |
| Contech Construction Products Inc. Short Term Disability Plan | - | 432 | - | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 52 | - | - | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 4 | - | - | - |
| 2000 | 8 | 956 | $67,209,281 | $4,644,016 | $4,858iApproximate average salary by contribution assumption: employee only about $121,444 at 4% or $80,963 at 6%; with 50% employer match about $80,963 at 4% or $53,975 at 6%; with 100% employer match about $60,722 at 4% or $40,481 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 511 | $39,911,737 | $2,846,166 | $5,570iApproximate average salary by contribution assumption: employee only about $139,245 at 4% or $92,830 at 6%; with 50% employer match about $92,830 at 4% or $61,887 at 6%; with 100% employer match about $69,622 at 4% or $46,415 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 831 | $22,596,330 | $988,023 | $1,189iApproximate average salary by contribution assumption: employee only about $29,724 at 4% or $19,816 at 6%; with 50% employer match about $19,816 at 4% or $13,211 at 6%; with 100% employer match about $14,862 at 4% or $9,908 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 405 | $4,701,214 | $809,827 | $2,000iApproximate average salary by contribution assumption: employee only about $49,989 at 4% or $33,326 at 6%; with 50% employer match about $33,326 at 4% or $22,217 at 6%; with 100% employer match about $24,995 at 4% or $16,663 at 6%. |
| Contech Construction Products Inc Group Long Term Disability Plan | - | 746 | - | - | - |
| Contech Construction Products Inc. Short Term Disability Plan | - | 455 | - | - | - |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | - | 956 | - | - | - |
| Contech Construction Products Inc. Pension Agreement Plan | - | 6 | - | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 41 | - | - | - |
| 1999 | 9 | 959 | $80,323,131 | $5,466,729 | $5,700iApproximate average salary by contribution assumption: employee only about $142,511 at 4% or $95,007 at 6%; with 50% employer match about $95,007 at 4% or $63,338 at 6%; with 100% employer match about $71,256 at 4% or $47,504 at 6%. |
| Ccpi Salaried Savings Plus Plan | - | 494 | $45,946,785 | $2,651,543 | $5,367iApproximate average salary by contribution assumption: employee only about $134,187 at 4% or $89,458 at 6%; with 50% employer match about $89,458 at 4% or $59,639 at 6%; with 100% employer match about $67,094 at 4% or $44,729 at 6%. |
| Contech Construction Products Inc. Profit Sharing Plan | - | 921 | $27,200,999 | $1,803,687 | $1,958iApproximate average salary by contribution assumption: employee only about $48,960 at 4% or $32,640 at 6%; with 50% employer match about $32,640 at 4% or $21,760 at 6%; with 100% employer match about $24,480 at 4% or $16,320 at 6%. |
| Contech Construction Products Inc. Savings Plus Plan for Eligible Hourly Employees | - | 380 | $4,966,555 | $773,269 | $2,035iApproximate average salary by contribution assumption: employee only about $50,873 at 4% or $33,915 at 6%; with 50% employer match about $33,915 at 4% or $22,610 at 6%; with 100% employer match about $25,436 at 4% or $16,958 at 6%. |
| Contech Construction Products Inc. Pension Agreement Plan | - | 9 | $1,705,376 | - | - |
| Contech Construction Products Inc. Retirement Savings Plan | - | 62 | $503,416 | $160,452 | $2,588iApproximate average salary by contribution assumption: employee only about $64,698 at 4% or $43,132 at 6%; with 50% employer match about $43,132 at 4% or $28,755 at 6%; with 100% employer match about $32,349 at 4% or $21,566 at 6%. |
| Contech Construction Products Inc. Comprehensive Health Care, Life Insurance and Sickness and Accident Plan | Current | 959 | - | - | - |
| Contech Construction Products Inc. Short Term Disability Plan | - | 431 | - | - | - |
| Contech Construction Products Inc Group Long Term Disability Plan | - | 786 | - | - | - |
| Contech Construction Products Inc. Noncontributory Pension Plan for Eligible Hourly Employees | - | 0 | - | $77,778 | - |
Schedule Details
Schedule A
- Row 1
- Filing Id
- 56037130198041
- Form Id
- 4621424
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040010
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 2
- Filing Id
- 56037130198041
- Form Id
- 4621417
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040003
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 3
- Filing Id
- 56037130198041
- Form Id
- 4621418
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040004
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 4
- Filing Id
- 56037130198041
- Form Id
- 4621416
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040002
- Ins Broker 01 Name
- WILSON MCBRIDE, INC. (IL)
- Ins Broker Comm Pd 01 Amount
- $14,250
- Ins Broker Fees Pd 01 Amount
- $0
- Row 5
- Filing Id
- 56037130198041
- Form Id
- 4621428
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040014
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 6
- Filing Id
- 56037130198041
- Form Id
- 4621429
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040015
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 7
- Filing Id
- 56037130198041
- Form Id
- 4621425
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040011
- Ins Broker 01 Name
- POHL & ASSOCIATES, INC.
- Ins Broker 01 Street Addr
- 4710 WEST SAGINAW
- Ins Broker 01 City
- LANSING
- Ins Broker 01 State
- MI
- Ins Broker 01 ZIP Code
- 48917
- Ins Broker Comm Pd 01 Amount
- $1,556
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 8
- Filing Id
- 56037130198041
- Form Id
- 4621426
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040012
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 9
- Filing Id
- 56037130198041
- Form Id
- 4621434
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040020
- Ins Broker 01 Name
- KUHL & COMPANY
- Ins Broker 01 Street Addr
- 632 W. JEFFERSON
- Ins Broker 01 City
- MORTON
- Ins Broker 01 State
- IL
- Ins Broker 01 ZIP Code
- 61550
- Ins Broker Comm Pd 01 Amount
- $5,832
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 10
- Filing Id
- 56037130198041
- Form Id
- 4621435
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040021
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 11
- Filing Id
- 56037130198041
- Form Id
- 4621436
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040022
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 12
- Filing Id
- 56037130198041
- Form Id
- 4621437
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040023
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 13
- Filing Id
- 56037130198041
- Form Id
- 4621438
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040024
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 14
- Filing Id
- 56037130198041
- Form Id
- 4621439
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040025
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 15
- Filing Id
- 56037130198041
- Form Id
- 4621440
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040026
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 16
- Filing Id
- 56037130198041
- Form Id
- 4621441
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040027
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 17
- Filing Id
- 56037130198041
- Form Id
- 4621443
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040029
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 18
- Filing Id
- 56037130198041
- Form Id
- 4621444
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040030
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 19
- Filing Id
- 56037130198041
- Form Id
- 4621430
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040016
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 20
- Filing Id
- 56037130198041
- Form Id
- 4621431
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040017
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 21
- Filing Id
- 56037130198041
- Form Id
- 4621432
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040018
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 22
- Filing Id
- 56037130198041
- Form Id
- 4621433
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040019
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 23
- Filing Id
- 56037130198041
- Form Id
- 4621419
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040005
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 24
- Filing Id
- 56037130198041
- Form Id
- 4621420
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040006
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 25
- Filing Id
- 56037130198041
- Form Id
- 4621421
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040007
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 26
- Filing Id
- 56037130198041
- Form Id
- 4621422
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040008
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 27
- Filing Id
- 56037130198041
- Form Id
- 4621423
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040009
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 28
- Filing Id
- 56037130198041
- Form Id
- 4621445
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040031
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 29
- Filing Id
- 56037130198041
- Form Id
- 4621446
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040032
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 30
- Filing Id
- 56037130198041
- Form Id
- 4621447
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040033
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 31
- Filing Id
- 56037130198041
- Form Id
- 4621448
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040034
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 32
- Filing Id
- 56037130198041
- Form Id
- 4621449
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040035
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 33
- Filing Id
- 56037130198041
- Form Id
- 4621450
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040036
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 34
- Filing Id
- 56037130198041
- Form Id
- 4621451
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040037
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 35
- Filing Id
- 56037130198041
- Form Id
- 4621452
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040038
- Ins Broker 01 Name
- GBS INSURANCE
- Ins Broker 01 Street Addr
- 525 EAST 100 SOUTH, SUITE 200
- Ins Broker 01 City
- SALT LAKE CITY
- Ins Broker 01 State
- UT
- Ins Broker 01 ZIP Code
- 84102
- Ins Broker Comm Pd 01 Amount
- $5,214
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 36
- Filing Id
- 56037130198041
- Form Id
- 4621427
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040013
- Ins Broker 01 Name
- JOHNSON & HIGGINS OF OHIO
- Ins Broker 01 Street Addr
- 525 VINE ST., SUITE 1500
- Ins Broker 01 City
- CINCINNATI
- Ins Broker 01 State
- OH
- Ins Broker 01 ZIP Code
- 45202
- Ins Broker Comm Pd 01 Amount
- $1,197
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 37
- Filing Id
- 56037130198041
- Form Id
- 4621442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 10371130198040028
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 38
- Ins Carrier Name: CIGNA HEALTHCARE OF GA - ATLANTA
- Filing Id
- 56037130198041
- Form Id
- 4621448
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF GA - ATLANTA
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 4661
- Ins Prsn Covered End of year Count
- 4
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $18,279
- Wlfr Acquis Cost Amount
- $0
- Row 39
- Ins Carrier Name: CIGNA HEALTHCARE OF TX - DALLAS
- Filing Id
- 56037130198041
- Form Id
- 4621449
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF TX - DALLAS
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1650
- Ins Prsn Covered End of year Count
- 2
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $7,342
- Wlfr Acquis Cost Amount
- $0
- Row 40
- Ins Carrier Name: CIGNA HEALTHCARE OF TX - DALLAS
- Filing Id
- 56037130198041
- Form Id
- 4621450
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF TX - DALLAS
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1651
- Ins Prsn Covered End of year Count
- 7
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $29,237
- Wlfr Acquis Cost Amount
- $0
- Row 41
- Ins Carrier Name: ALTIUS HEALTH PLANS, INC.
- Filing Id
- 56037130198041
- Form Id
- 4621452
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- ALTIUS HEALTH PLANS, INC.
- Ins Carrier EIN
- 87-0345631
- Ins Carrier Naic Code
- 95407
- Ins Contract Num
- 17001
- Ins Prsn Covered End of year Count
- 11
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $5,214
- 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
- AHJ
- 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
- $52,140
- Wlfr Acquis Cost Amount
- $0
- Row 42
- Ins Carrier Name: PARTNERS NATIONAL HEALTH PLANS OF NORTH CAROLINA, INC.
- Filing Id
- 56037130198041
- Form Id
- 4621426
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- PARTNERS NATIONAL HEALTH PLANS OF NORTH CAROLINA, INC.
- Ins Carrier EIN
- 56-1526375
- Ins Carrier Naic Code
- 95300
- Ins Contract Num
- 5906
- Ins Prsn Covered End of year Count
- 22
- Ins Policy From Date
- 1999-12-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $5,869
- Wlfr Acquis Cost Amount
- $0
- Row 43
- Ins Carrier Name: AMERICAN HEALTH CARE PROVIDERS, INC.
- Filing Id
- 56037130198041
- Form Id
- 4621451
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- AMERICAN HEALTH CARE PROVIDERS, INC.
- Ins Contract Num
- IL01560
- Ins Prsn Covered End of year Count
- 62
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $333,250
- Wlfr Acquis Cost Amount
- $0
- Row 44
- Ins Carrier Name: XANTUS HEALTHPLAN OF MS., INC.
- Filing Id
- 56037130198041
- Form Id
- 4621417
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- XANTUS HEALTHPLAN OF MS., INC.
- Ins Carrier EIN
- 64-0870834
- Ins Carrier Naic Code
- 95464
- Ins Contract Num
- M50301
- Ins Prsn Covered End of year Count
- 19
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-09-30
- 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
- AHJ
- Wlfr Premium Rcvd Amount
- $102,118
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $102,118
- 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
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 45
- Ins Carrier Name: QUALMED PLANS FOR HEALTH OF NEW MEXICO
- Filing Id
- 56037130198041
- Form Id
- 4621423
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- QUALMED PLANS FOR HEALTH OF NEW MEXICO
- Ins Contract Num
- 900881
- Ins Prsn Covered End of year Count
- 21
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $83,014
- Wlfr Acquis Cost Amount
- $0
- Row 46
- Ins Carrier Name: UNITED HEALTHCARE OF KENTUCKY
- Filing Id
- 56037130198041
- Form Id
- 4621424
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- UNITED HEALTHCARE OF KENTUCKY
- Ins Contract Num
- 100421/10178
- Ins Prsn Covered End of year Count
- 62
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $238,808
- Wlfr Acquis Cost Amount
- $0
- Row 47
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF NORTH CAROLINA
- Filing Id
- 56037130198041
- Form Id
- 4621433
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF NORTH CAROLINA
- Ins Carrier Naic Code
- 95669
- Ins Contract Num
- 1029
- Ins Prsn Covered End of year Count
- 22
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-11-30
- 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
- $70,919
- Wlfr Acquis Cost Amount
- $0
- Row 48
- Ins Carrier Name: CIGNA HEALTHCARE OF AZ - PHOENIX
- Filing Id
- 56037130198041
- Form Id
- 4621444
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF AZ - PHOENIX
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 0713
- Ins Prsn Covered End of year Count
- 8
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $35,620
- Wlfr Acquis Cost Amount
- $0
- Row 49
- Ins Carrier Name: CONNECTICUT GENERAL LIFE INSURANCE COMPANY
- Filing Id
- 56037130198041
- Form Id
- 4621416
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CONNECTICUT GENERAL LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 2084262
- Ins Prsn Covered End of year Count
- 1,128
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $14,250
- 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
- $124,709
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $124,709
- Wlfr Claims Paid Amount
- $75,307
- Wlfr Incr Reserve Amount
- $1,307
- Wlfr Incurred Claim Amount
- $76,614
- Wlfr Claims Chrgd Amount
- $76,614
- Wlfr Ret Commissions Amount
- $14,250
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $24,492
- Wlfr Ret Taxes Amount
- $5,119
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $43,861
- Wlfr Refund Indicator
- Yes
- Wlfr Refund Amount
- $4,234
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $31,449
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $18,990
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 50
- Ins Carrier Name: UNITY HEALTH PLANS INC.
- Filing Id
- 56037130198041
- Form Id
- 4621418
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- UNITY HEALTH PLANS INC.
- Ins Carrier EIN
- 39-1450766
- Ins Carrier Naic Code
- 95796
- Ins Contract Num
- 00560
- Ins Prsn Covered End of year Count
- 13
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $34,774
- Wlfr Acquis Cost Amount
- $0
- Row 51
- Ins Carrier Name: CIGNA GROUP INSURANCE
- Filing Id
- 56037130198041
- Form Id
- 4621419
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA GROUP INSURANCE
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- COA001662
- Ins Prsn Covered End of year Count
- 912
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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 Oth Text
- ACCIDENTAL DEATH & DISMEMBERMENT
- Wlfr Premium Rcvd Amount
- $15,758
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $15,758
- 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
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 52
- Ins Carrier Name: CONNECTICUT GENERAL LIFE INSURANCE COMPANY
- Filing Id
- 56037130198041
- Form Id
- 4621420
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CONNECTICUT GENERAL LIFE INSURANCE COMPANY
- Ins Contract Num
- 2084262
- Ins Prsn Covered End of year Count
- 193
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- D
- Wlfr Premium Rcvd Amount
- $71,934
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $71,934
- 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
- $71,934
- Wlfr Acquis Cost Amount
- $0
- Row 53
- Ins Carrier Name: UNITED HEALTHCARE OF ALABAMA
- Filing Id
- 56037130198041
- Form Id
- 4621421
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- UNITED HEALTHCARE OF ALABAMA
- Ins Contract Num
- 105436/31591
- Ins Prsn Covered End of year Count
- 28
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $165,253
- Wlfr Acquis Cost Amount
- $0
- Row 54
- Ins Carrier Name: UNIVERA HEALTHCARE
- Filing Id
- 56037130198041
- Form Id
- 4621422
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- UNIVERA HEALTHCARE
- Ins Carrier EIN
- 16-1057746
- Ins Carrier Naic Code
- 95496
- Ins Contract Num
- 1337
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $2,022
- Wlfr Acquis Cost Amount
- $0
- Row 55
- Ins Carrier Name: PHP OF MID MICHIGAN
- Filing Id
- 56037130198041
- Form Id
- 4621425
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- PHP OF MID MICHIGAN
- Ins Carrier EIN
- 38-2356288
- Ins Carrier Naic Code
- 99917
- Ins Contract Num
- 101018/60193
- Ins Prsn Covered End of year Count
- 7
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $1,556
- 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
- AHJ
- Wlfr Premium Rcvd Amount
- $29,392
- Wlfr Unpaid Due Amount
- $2,910
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $32,302
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $1,556
- 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
- $1,556
- 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 56
- Ins Carrier Name: PACIFICARE
- Filing Id
- 56037130198041
- Form Id
- 4621427
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- PACIFICARE
- Ins Contract Num
- 02400
- Ins Prsn Covered End of year Count
- 25
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- Ins Broker Comm Total Amount
- $1,197
- 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
- AHJ
- Wlfr Premium Rcvd Amount
- $102,565
- Wlfr Unpaid Due Amount
- $1,134
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $103,699
- 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
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 57
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF COLORADO
- Filing Id
- 56037130198041
- Form Id
- 4621432
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF COLORADO
- Ins Carrier EIN
- 84-0591617
- Ins Carrier Naic Code
- 95639
- Ins Contract Num
- 0474
- Ins Prsn Covered End of year Count
- 11
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $47,985
- Wlfr Acquis Cost Amount
- $0
- Row 58
- Ins Carrier Name: NATIONAL HEALTH PLANS
- Filing Id
- 56037130198041
- Form Id
- 4621428
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- NATIONAL HEALTH PLANS
- Ins Contract Num
- 0000477
- Ins Prsn Covered End of year Count
- 16
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $73,090
- Wlfr Acquis Cost Amount
- $0
- Row 59
- Ins Carrier Name: MID-VALLEY CARENET
- Filing Id
- 56037130198041
- Form Id
- 4621429
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- MID-VALLEY CARENET
- Ins Contract Num
- 0050
- Ins Prsn Covered End of year Count
- 71
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- Wlfr Premium Rcvd Amount
- $308,059
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $308,059
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $2,301
- Wlfr Ret Admin Amount
- $135,778
- 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
- $138,079
- 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 60
- Ins Carrier Name: MEDICA CHOICE
- Filing Id
- 56037130198041
- Form Id
- 4621430
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- MEDICA CHOICE
- Ins Contract Num
- 105460-60473
- Ins Prsn Covered End of year Count
- 37
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $180,121
- Wlfr Acquis Cost Amount
- $0
- Row 61
- Ins Carrier Name: MAMSI LIFE AND HEALTH INSURANCE COMPANY
- Filing Id
- 56037130198041
- Form Id
- 4621431
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- MAMSI LIFE AND HEALTH INSURANCE COMPANY
- Ins Contract Num
- 25947
- Ins Prsn Covered End of year Count
- 8
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $46,991
- Wlfr Acquis Cost Amount
- $0
- Row 62
- Ins Carrier Name: JOHN ALDEN LIFE INSURANCE COMPANY
- Filing Id
- 56037130198041
- Form Id
- 4621434
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- JOHN ALDEN LIFE INSURANCE COMPANY
- Ins Contract Num
- 951470
- Ins Prsn Covered End of year Count
- 26
- Ins Policy From Date
- 1999-01-15
- Ins Policy To Date
- 1999-12-15
- Ins Broker Comm Total Amount
- $5,832
- 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
- AHJ
- 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
- $83,981
- Wlfr Acquis Cost Amount
- $0
- Row 63
- Ins Carrier Name: HEALTH NEW ENGLAND
- Filing Id
- 56037130198041
- Form Id
- 4621435
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- HEALTH NEW ENGLAND
- Ins Carrier EIN
- 04-2864973
- Ins Carrier Naic Code
- 95673
- Ins Contract Num
- 111310
- Ins Prsn Covered End of year Count
- 23
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- Wlfr Premium Rcvd Amount
- $131,121
- Wlfr Unpaid Due Amount
- $563
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $131,684
- 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
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 64
- Ins Carrier Name: HEALTHCENTRAL, INC.
- Filing Id
- 56037130198041
- Form Id
- 4621436
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- HEALTHCENTRAL, INC.
- Ins Carrier EIN
- 25-1743176
- Ins Carrier Naic Code
- 95228
- Ins Contract Num
- 000102
- Ins Prsn Covered End of year Count
- 26
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $119,390
- Wlfr Acquis Cost Amount
- $0
- Row 65
- Ins Carrier Name: CIGNA HEALTHCARE OF SOUTH FLORIDA
- Filing Id
- 56037130198041
- Form Id
- 4621437
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF SOUTH FLORIDA
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1424
- Ins Prsn Covered End of year Count
- 4
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $20,485
- Wlfr Acquis Cost Amount
- $0
- Row 66
- Ins Carrier Name: CIGNA HEALTHCARE OF SOUTH FLORIDA
- Filing Id
- 56037130198041
- Form Id
- 4621438
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF SOUTH FLORIDA
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1425
- Ins Prsn Covered End of year Count
- 12
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $64,506
- Wlfr Acquis Cost Amount
- $0
- Row 67
- Ins Carrier Name: CIGNA HEALTHCARE OF FL - ORLANDO
- Filing Id
- 56037130198041
- Form Id
- 4621439
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF FL - ORLANDO
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- C052
- Ins Prsn Covered End of year Count
- 4
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $12,351
- Wlfr Acquis Cost Amount
- $0
- Row 68
- Ins Carrier Name: CIGNA HEALTHCARE OF NC - CHARLOTTE
- Filing Id
- 56037130198041
- Form Id
- 4621440
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF NC - CHARLOTTE
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1434
- Ins Prsn Covered End of year Count
- 9
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $40,727
- Wlfr Acquis Cost Amount
- $0
- Row 69
- Ins Carrier Name: CIGNA HEALTHCARE OF FL - TAMPA
- Filing Id
- 56037130198041
- Form Id
- 4621441
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF FL - TAMPA
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 0476
- Ins Prsn Covered End of year Count
- 10
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $36,618
- Wlfr Acquis Cost Amount
- $0
- Row 70
- Ins Carrier Name: CIGNA HEALTHCARE OF IL - CHICAGO
- Filing Id
- 56037130198041
- Form Id
- 4621442
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF IL - CHICAGO
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 0739
- Ins Prsn Covered End of year Count
- 3
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $15,063
- Wlfr Acquis Cost Amount
- $0
- Row 71
- Ins Carrier Name: CIGNA HEALTHCARE OF IL - CHICAGO
- Filing Id
- 56037130198041
- Form Id
- 4621443
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF IL - CHICAGO
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 0740
- Ins Prsn Covered End of year Count
- 5
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $26,179
- Wlfr Acquis Cost Amount
- $0
- Row 72
- Ins Carrier Name: CIGNA HEALTHCARE OF AZ - PHOENIX
- Filing Id
- 56037130198041
- Form Id
- 4621445
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF AZ - PHOENIX
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 1006
- Ins Prsn Covered End of year Count
- 2
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $8,417
- Wlfr Acquis Cost Amount
- $0
- Row 73
- Ins Carrier Name: CIGNA HEALTHCARE OF CA - LOS ANGELES
- Filing Id
- 56037130198041
- Form Id
- 4621446
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF CA - LOS ANGELES
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- M123
- Ins Prsn Covered End of year Count
- 11
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $50,714
- Wlfr Acquis Cost Amount
- $0
- Row 74
- Ins Carrier Name: CIGNA HEALTHCARE OF GA - ATLANTA
- Filing Id
- 56037130198041
- Form Id
- 4621447
- Schedule A EIN
- 31-1177165
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 1999-01-01
- Schedule A Tax Period
- 19991231
- Ins Carrier Name
- CIGNA HEALTHCARE OF GA - ATLANTA
- Ins Carrier EIN
- 06-0303370
- Ins Contract Num
- 4312
- Ins Prsn Covered End of year Count
- 23
- Ins Policy From Date
- 1999-01-01
- Ins Policy To Date
- 1999-12-31
- 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
- AHJ
- 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
- $94,518
- Wlfr Acquis Cost Amount
- $0