Civic Intelligence
Filing

HEALTH AND WELFARE BENEFIT PLAN

Alliance of Community Hospices Inc • EIN 61-0921718 • Plan year 2007

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Filing Insights

Participants

Down

302 → 289

-13 • -4.30%

Assets

No comparison

- → -

No earlier value available.

Investment Management Fee

-

Admin expenses - • Total expenses -

Filing Details

Context

No event flags were generated for this filing.

Status Flags

Fidelity bond in place

Not reported

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

Not reported

Leases in default

Not reported

Reportable party-in-interest issues

Not reported

Loss discovered during year

Not reported

Assets with undetermined value

Not reported

Non-cash contributions

Not reported

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

Not reported

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

Not reported

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
20242656$53,223,724$6,340,898$9,666iApproximate average salary by contribution assumption: employee only about $241,650 at 4% or $161,100 at 6%; with 50% employer match about $161,100 at 4% or $107,400 at 6%; with 100% employer match about $120,825 at 4% or $80,550 at 6%.
Alliance of Community Hospices Inc. 401K Plan-639$53,223,724$6,340,898$9,923iApproximate average salary by contribution assumption: employee only about $248,079 at 4% or $165,386 at 6%; with 50% employer match about $165,386 at 4% or $110,257 at 6%; with 100% employer match about $124,039 at 4% or $82,693 at 6%.
Hosparus Health and Welfare Plan-656---
20232634$44,889,696$5,719,569$9,021iApproximate average salary by contribution assumption: employee only about $225,535 at 4% or $150,357 at 6%; with 50% employer match about $150,357 at 4% or $100,238 at 6%; with 100% employer match about $112,768 at 4% or $75,178 at 6%.
Alliance of Community Hospices Inc. 401K Plan-606$44,889,696$5,719,569$9,438iApproximate average salary by contribution assumption: employee only about $235,956 at 4% or $157,304 at 6%; with 50% employer match about $157,304 at 4% or $104,869 at 6%; with 100% employer match about $117,978 at 4% or $78,652 at 6%.
Hosparus Health and Welfare Plan-634---
20222588$36,555,646$5,459,691$9,285iApproximate average salary by contribution assumption: employee only about $232,130 at 4% or $154,753 at 6%; with 50% employer match about $154,753 at 4% or $103,169 at 6%; with 100% employer match about $116,065 at 4% or $77,377 at 6%.
Alliance of Community Hospices Inc. 401K Plan-571$36,555,646$5,459,691$9,562iApproximate average salary by contribution assumption: employee only about $239,041 at 4% or $159,361 at 6%; with 50% employer match about $159,361 at 4% or $106,240 at 6%; with 100% employer match about $119,520 at 4% or $79,680 at 6%.
Hosparus Health and Welfare Plan-588---
20212581$41,532,165$5,963,013$10,263iApproximate average salary by contribution assumption: employee only about $256,584 at 4% or $171,056 at 6%; with 50% employer match about $171,056 at 4% or $114,037 at 6%; with 100% employer match about $128,292 at 4% or $85,528 at 6%.
Alliance of Community Hospices Inc. 401K Plan-581$41,532,165$5,963,013$10,263iApproximate average salary by contribution assumption: employee only about $256,584 at 4% or $171,056 at 6%; with 50% employer match about $171,056 at 4% or $114,037 at 6%; with 100% employer match about $128,292 at 4% or $85,528 at 6%.
Hosparus Health and Welfare Plan-560---
20202608$34,571,461$4,811,451$7,914iApproximate average salary by contribution assumption: employee only about $197,839 at 4% or $131,893 at 6%; with 50% employer match about $131,893 at 4% or $87,929 at 6%; with 100% employer match about $98,920 at 4% or $65,946 at 6%.
Alliance of Community Hospices Inc. 401K Plan-608$34,571,461$4,811,451$7,914iApproximate average salary by contribution assumption: employee only about $197,839 at 4% or $131,893 at 6%; with 50% employer match about $131,893 at 4% or $87,929 at 6%; with 100% employer match about $98,920 at 4% or $65,946 at 6%.
Hosparus Health and Welfare Plan-569---
20192626$29,715,689$4,659,177$7,443iApproximate average salary by contribution assumption: employee only about $186,069 at 4% or $124,046 at 6%; with 50% employer match about $124,046 at 4% or $82,697 at 6%; with 100% employer match about $93,035 at 4% or $62,023 at 6%.
Alliance of Community Hospices Inc. 401K Plan-626$29,715,689$4,659,177$7,443iApproximate average salary by contribution assumption: employee only about $186,069 at 4% or $124,046 at 6%; with 50% employer match about $124,046 at 4% or $82,697 at 6%; with 100% employer match about $93,035 at 4% or $62,023 at 6%.
Hosparus Health and Welfare Plan-616---
20182620$23,879,688$3,755,083$6,057iApproximate average salary by contribution assumption: employee only about $151,415 at 4% or $100,943 at 6%; with 50% employer match about $100,943 at 4% or $67,295 at 6%; with 100% employer match about $75,707 at 4% or $50,472 at 6%.
Alliance of Community Hospices Inc. 401K Plan-569$23,879,688$3,755,083$6,599iApproximate average salary by contribution assumption: employee only about $164,986 at 4% or $109,991 at 6%; with 50% employer match about $109,991 at 4% or $73,327 at 6%; with 100% employer match about $82,493 at 4% or $54,995 at 6%.
Hosparus Health and Welfare Plan-620---
20172530$25,080,245$3,341,224$6,304iApproximate average salary by contribution assumption: employee only about $157,605 at 4% or $105,070 at 6%; with 50% employer match about $105,070 at 4% or $70,047 at 6%; with 100% employer match about $78,802 at 4% or $52,535 at 6%.
Alliance of Community Hospices Inc. 401K Plan-485$25,080,245$3,341,224$6,889iApproximate average salary by contribution assumption: employee only about $172,228 at 4% or $114,819 at 6%; with 50% employer match about $114,819 at 4% or $76,546 at 6%; with 100% employer match about $86,114 at 4% or $57,409 at 6%.
Hosparus Health and Welfare Plan-530---
20162449$20,383,177$2,597,912$5,786iApproximate average salary by contribution assumption: employee only about $144,650 at 4% or $96,433 at 6%; with 50% employer match about $96,433 at 4% or $64,289 at 6%; with 100% employer match about $72,325 at 4% or $48,217 at 6%.
Alliance of Community Hospices Inc. 401K Plan-449$20,383,177$2,597,912$5,786iApproximate average salary by contribution assumption: employee only about $144,650 at 4% or $96,433 at 6%; with 50% employer match about $96,433 at 4% or $64,289 at 6%; with 100% employer match about $72,325 at 4% or $48,217 at 6%.
Hosparus Health and Welfare Plan-336---
20152388$17,981,782$2,018,557$5,202iApproximate average salary by contribution assumption: employee only about $130,062 at 4% or $86,708 at 6%; with 50% employer match about $86,708 at 4% or $57,805 at 6%; with 100% employer match about $65,031 at 4% or $43,354 at 6%.
Alliance of Community Hospices Inc. 401K Plan-388$17,981,782$2,018,557$5,202iApproximate average salary by contribution assumption: employee only about $130,062 at 4% or $86,708 at 6%; with 50% employer match about $86,708 at 4% or $57,805 at 6%; with 100% employer match about $65,031 at 4% or $43,354 at 6%.
Hosparus Health and Welfare Plan-330---
20143446$18,834,403$2,076,647$4,656iApproximate average salary by contribution assumption: employee only about $116,404 at 4% or $77,603 at 6%; with 50% employer match about $77,603 at 4% or $51,735 at 6%; with 100% employer match about $58,202 at 4% or $38,801 at 6%.
Alliance of Community Hospices Inc. 401K Plan-415$18,834,403$2,076,647$5,004iApproximate average salary by contribution assumption: employee only about $125,099 at 4% or $83,399 at 6%; with 50% employer match about $83,399 at 4% or $55,600 at 6%; with 100% employer match about $62,550 at 4% or $41,700 at 6%.
Hosparus Health and Welfare Plan-446---
HEALTH & WELFARE-0---
20133449$17,866,215$2,516,054$5,604iApproximate average salary by contribution assumption: employee only about $140,092 at 4% or $93,395 at 6%; with 50% employer match about $93,395 at 4% or $62,263 at 6%; with 100% employer match about $70,046 at 4% or $46,697 at 6%.
Alliance of Community Hospices Inc. 401K Plan-449$17,866,215$2,516,054$5,604iApproximate average salary by contribution assumption: employee only about $140,092 at 4% or $93,395 at 6%; with 50% employer match about $93,395 at 4% or $62,263 at 6%; with 100% employer match about $70,046 at 4% or $46,697 at 6%.
LIFE INSURANCE, AD&D AND LTD PLAN-440---
HEALTH & WELFARE-344---
20123459$13,595,502$2,088,293$4,550iApproximate average salary by contribution assumption: employee only about $113,741 at 4% or $75,828 at 6%; with 50% employer match about $75,828 at 4% or $50,552 at 6%; with 100% employer match about $56,871 at 4% or $37,914 at 6%.
Alliance of Community Hospices Inc. 401K Plan-429$13,595,502$2,088,293$4,868iApproximate average salary by contribution assumption: employee only about $121,695 at 4% or $81,130 at 6%; with 50% employer match about $81,130 at 4% or $54,087 at 6%; with 100% employer match about $60,848 at 4% or $40,565 at 6%.
LIFE INSURANCE, AD&D AND LTD PLAN-459---
HEALTH & WELFARE-343---
20113442$11,818,029$2,275,811$5,149iApproximate average salary by contribution assumption: employee only about $128,722 at 4% or $85,815 at 6%; with 50% employer match about $85,815 at 4% or $57,210 at 6%; with 100% employer match about $64,361 at 4% or $42,907 at 6%.
Alliance of Community Hospices Inc. 401K Plan-442$11,818,029$2,275,811$5,149iApproximate average salary by contribution assumption: employee only about $128,722 at 4% or $85,815 at 6%; with 50% employer match about $85,815 at 4% or $57,210 at 6%; with 100% employer match about $64,361 at 4% or $42,907 at 6%.
LIFE INSURANCE, AD&D AND LTD PLAN-421---
HEALTH & WELFARE PLAN-363---
20103403$11,087,192$1,414,588$3,510iApproximate average salary by contribution assumption: employee only about $87,754 at 4% or $58,502 at 6%; with 50% employer match about $58,502 at 4% or $39,002 at 6%; with 100% employer match about $43,877 at 4% or $29,251 at 6%.
Alliance of Community Hospices Inc. 401K Plan-376$11,087,192$1,414,588$3,762iApproximate average salary by contribution assumption: employee only about $94,055 at 4% or $62,703 at 6%; with 50% employer match about $62,703 at 4% or $41,802 at 6%; with 100% employer match about $47,028 at 4% or $31,352 at 6%.
LIFE INSURANCE, AD&D AND LTD PLAN-403---
HEALTH & WELFARE PLAN-340---
20093341$9,015,223$1,340,007$3,930iApproximate average salary by contribution assumption: employee only about $98,241 at 4% or $65,494 at 6%; with 50% employer match about $65,494 at 4% or $43,663 at 6%; with 100% employer match about $49,120 at 4% or $32,747 at 6%.
Alliance of Community Hospices Inc. 401K Plan-334$9,015,223$1,340,007$4,012iApproximate average salary by contribution assumption: employee only about $100,300 at 4% or $66,867 at 6%; with 50% employer match about $66,867 at 4% or $44,578 at 6%; with 100% employer match about $50,150 at 4% or $33,433 at 6%.
AD&D AND LTD PLAN-341---
HEALTH AND WELFARE BENEFIT PLAN-325---
20081340$6,896,309$1,395,704$4,105iApproximate average salary by contribution assumption: employee only about $102,625 at 4% or $68,417 at 6%; with 50% employer match about $68,417 at 4% or $45,611 at 6%; with 100% employer match about $51,313 at 4% or $34,208 at 6%.
Alliance of Community Hospices Inc. 401K Plan-340$6,896,309$1,395,704$4,105iApproximate average salary by contribution assumption: employee only about $102,625 at 4% or $68,417 at 6%; with 50% employer match about $68,417 at 4% or $45,611 at 6%; with 100% employer match about $51,313 at 4% or $34,208 at 6%.
20073345$8,615,243$1,415,077$4,102iApproximate average salary by contribution assumption: employee only about $102,542 at 4% or $68,361 at 6%; with 50% employer match about $68,361 at 4% or $45,574 at 6%; with 100% employer match about $51,271 at 4% or $34,181 at 6%.
Alliance of Community Hospices Inc. 401K Plan-345$8,615,243$1,415,077$4,102iApproximate average salary by contribution assumption: employee only about $102,542 at 4% or $68,361 at 6%; with 50% employer match about $68,361 at 4% or $45,574 at 6%; with 100% employer match about $51,271 at 4% or $34,181 at 6%.
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-322---
HEALTH AND WELFARE BENEFIT PLANCurrent289---
20063330$7,580,493$1,366,550$4,141iApproximate average salary by contribution assumption: employee only about $103,527 at 4% or $69,018 at 6%; with 50% employer match about $69,018 at 4% or $46,012 at 6%; with 100% employer match about $51,763 at 4% or $34,509 at 6%.
Alliance of Community Hospices Inc. 401K Plan-330$7,580,493$1,366,550$4,141iApproximate average salary by contribution assumption: employee only about $103,527 at 4% or $69,018 at 6%; with 50% employer match about $69,018 at 4% or $46,012 at 6%; with 100% employer match about $51,763 at 4% or $34,509 at 6%.
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-316---
HEALTH AND WELFARE BENEFIT PLAN-302---
20053388$6,327,716$1,436,786$3,703iApproximate average salary by contribution assumption: employee only about $92,576 at 4% or $61,718 at 6%; with 50% employer match about $61,718 at 4% or $41,145 at 6%; with 100% employer match about $46,288 at 4% or $30,859 at 6%.
Alliance of Community Hospices Inc. 401K Plan-385$6,327,716$1,436,786$3,732iApproximate average salary by contribution assumption: employee only about $93,298 at 4% or $62,199 at 6%; with 50% employer match about $62,199 at 4% or $41,466 at 6%; with 100% employer match about $46,649 at 4% or $31,099 at 6%.
HEALTH AND WELFARE BENEFIT PLAN-319---
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-388---
20043365$4,764,569$1,192,572$3,267iApproximate average salary by contribution assumption: employee only about $81,683 at 4% or $54,455 at 6%; with 50% employer match about $54,455 at 4% or $36,304 at 6%; with 100% employer match about $40,842 at 4% or $27,228 at 6%.
Alliance of Community Hospices Inc. 401K Plan-351$4,764,569$1,192,572$3,398iApproximate average salary by contribution assumption: employee only about $84,941 at 4% or $56,627 at 6%; with 50% employer match about $56,627 at 4% or $37,752 at 6%; with 100% employer match about $42,471 at 4% or $28,314 at 6%.
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-365---
HEALTH AND WELFARE BENEFIT PLAN-314---
20033311$3,327,104$870,556$2,799iApproximate average salary by contribution assumption: employee only about $69,980 at 4% or $46,654 at 6%; with 50% employer match about $46,654 at 4% or $31,102 at 6%; with 100% employer match about $34,990 at 4% or $23,327 at 6%.
Alliance of Community Hospices Inc. 401K Plan-307$3,327,104$870,556$2,836iApproximate average salary by contribution assumption: employee only about $70,892 at 4% or $47,261 at 6%; with 50% employer match about $47,261 at 4% or $31,508 at 6%; with 100% employer match about $35,446 at 4% or $23,631 at 6%.
HEALTH AND WELFARE BENEFIT PLAN-297---
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-311---
20023265$2,084,127$802,497$3,028iApproximate average salary by contribution assumption: employee only about $75,707 at 4% or $50,472 at 6%; with 50% employer match about $50,472 at 4% or $33,648 at 6%; with 100% employer match about $37,854 at 4% or $25,236 at 6%.
Alliance of Community Hospices Inc. 401K Plan-259$2,084,127$802,497$3,098iApproximate average salary by contribution assumption: employee only about $77,461 at 4% or $51,641 at 6%; with 50% employer match about $51,641 at 4% or $34,427 at 6%; with 100% employer match about $38,731 at 4% or $25,820 at 6%.
HEALTH AND WELFARE BENEFIT PLAN-265---
ACCIDENTAL DEATH AND DISMEABERMENT AND LDNG TERM DISABILITY PLAN-265---
20013238$1,754,953$703,549$2,956iApproximate average salary by contribution assumption: employee only about $73,902 at 4% or $49,268 at 6%; with 50% employer match about $49,268 at 4% or $32,845 at 6%; with 100% employer match about $36,951 at 4% or $24,634 at 6%.
Alliance of Community Hospices Inc. 401K Plan-238$1,754,953$703,549$2,956iApproximate average salary by contribution assumption: employee only about $73,902 at 4% or $49,268 at 6%; with 50% employer match about $49,268 at 4% or $32,845 at 6%; with 100% employer match about $36,951 at 4% or $24,634 at 6%.
HOSPICE OF LOUISVILLE EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN-225---
HOSPICE OF LOUISVILLE INC LIFE ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-225---
20003228$1,190,201$670,610$2,941iApproximate average salary by contribution assumption: employee only about $73,532 at 4% or $49,021 at 6%; with 50% employer match about $49,021 at 4% or $32,681 at 6%; with 100% employer match about $36,766 at 4% or $24,511 at 6%.
Alliance of Community Hospices Inc. 401K Plan-228$1,190,201$670,610$2,941iApproximate average salary by contribution assumption: employee only about $73,532 at 4% or $49,021 at 6%; with 50% employer match about $49,021 at 4% or $32,681 at 6%; with 100% employer match about $36,766 at 4% or $24,511 at 6%.
HOSPICE OF LOUISVILLE EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN-197---
HOSPICS OF LOUISVILLE INC LIFE ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG TERM DISABILITY PLAN-197---
19991216$652,280$583,998$2,704iApproximate average salary by contribution assumption: employee only about $67,592 at 4% or $45,062 at 6%; with 50% employer match about $45,062 at 4% or $30,041 at 6%; with 100% employer match about $33,796 at 4% or $22,531 at 6%.
Alliance of Community Hospices Inc. 401K Plan-216$652,280$583,998$2,704iApproximate average salary by contribution assumption: employee only about $67,592 at 4% or $45,062 at 6%; with 50% employer match about $45,062 at 4% or $30,041 at 6%; with 100% employer match about $33,796 at 4% or $22,531 at 6%.
Schedule Details

Schedule A

Row 1
Filing Id
84037344347318
Form Id
93249320
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060003
Ins Broker 01 Name
GREEN AND ASSOLIATTS INC
Ins Broker 01 Street Addr
521 BARRET AVE
Ins Broker 01 City
LOUISVILLE
Ins Broker 01 State
KY
Ins Broker 01 ZIP Code
40204
Ins Broker Comm Pd 01 Amount
$4,779
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 2
Filing Id
84037344347318
Form Id
93249323
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060006
Ins Broker 01 Name
GREEN AND ASSOCIATES JNC
Ins Broker 01 Street Addr
521 BARRET AVE
Ins Broker 01 City
LOUISVILLE
Ins Broker 01 State
KY
Ins Broker 01 ZIP Code
40204
Ins Broker Comm Pd 01 Amount
$586
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 3
Filing Id
84037344347318
Form Id
93249319
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060002
Ins Broker 01 Name
GREEN ANO ASSOLIATES INC
Ins Broker 01 Street Addr
521 BARRET AVE
Ins Broker 01 City
LOUISVILLE
Ins Broker 01 State
KY
Ins Broker 01 ZIP Code
40204
Ins Broker Comm Pd 01 Amount
$36,888
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 4
Filing Id
84037344347318
Form Id
93249321
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060004
Ins Broker 01 Name
GREEN ANO ASSOCIATES INC
Ins Broker 01 Street Addr
521 BARRET AVE
Ins Broker 01 City
LOUISVILLE
Ins Broker 01 State
KY
Ins Broker 01 ZIP Code
40204
Ins Broker Comm Pd 01 Amount
$725
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 5
Filing Id
84037344347318
Form Id
93249322
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060005
Ins Broker 01 Name
GREEN AND ASSOCIATES INC
Ins Broker 01 Street Addr
521 BARRET AVE
Ins Broker 01 City
LOUISVILLE
Ins Broker 01 State
KY
Ins Broker 01 ZIP Code
40205
Ins Broker Comm Pd 01 Amount
$3,849
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 6
Filing Id
84037344347318
Form Id
93249321
Page Id
2
Page Seq
0
Page Row Num
2
Row Num
1
Image Form Id
7020378344347060004
Ins Broker 01 ZIP Code
5
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 7
Filing Id
84037344347318
Form Id
93249319
Page Id
2
Page Seq
0
Page Row Num
2
Row Num
1
Image Form Id
7020378344347060002
Ins Broker 01 Name
MUMANA INSURANCE COMPAUY
Ins Broker 01 Street Addr
PO BOY O8SG
Ins Broker 01 City
CAROL STREAM
Ins Broker 01 State
IL
Ins Broker 01 ZIP Code
601320859
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$125,610
Ins Broker Fees Pd 01 Text
ADMINISTRATIVE FEES
Ins Broker 01 Code
5
Row 8
Ins Carrier Name: AMERICAN HERITAGE LIFE
Filing Id
84037344347318
Form Id
93249322
Schedule A EIN
61-0921718
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2007-01-01
Schedule A Tax Period
20071231
Ins Carrier Name
AMERICAN HERITAGE LIFE
Ins Carrier EIN
59-0781901
Ins Carrier Naic Code
60534
Ins Contract Num
54473
Ins Prsn Covered End of year Count
68
Ins Policy From Date
2007-01-01
Ins Policy To Date
2007-12-31
Ins Broker Comm Total Amount
$3,849
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
CANERIINTENSZVE CARE
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
$25,660
Wlfr Acquis Cost Amount
$0
Row 9
Ins Carrier Name: STANOARD INSURANCE COMFANY
Filing Id
84037344347318
Form Id
93249320
Schedule A EIN
61-0921718
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2007-01-01
Schedule A Tax Period
20071231
Ins Carrier Name
STANOARD INSURANCE COMFANY
Ins Carrier EIN
93-0242990
Ins Carrier Naic Code
69019
Ins Contract Num
637543
Ins Prsn Covered End of year Count
274
Ins Policy From Date
2007-01-01
Ins Policy To Date
2007-12-31
Ins Broker Comm Total Amount
$4,779
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
E
Wlfr Premium Rcvd Amount
$109,881
Wlfr Unpaid Due Amount
$9,941
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$119,822
Wlfr Claims Paid Amount
$95,565
Wlfr Incr Reserve Amount
$3,774
Wlfr Incurred Claim Amount
$99,339
Wlfr Claims Chrgd Amount
$99,339
Wlfr Ret Commissions Amount
$4,779
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$13,952
Wlfr Ret Taxes Amount
$1,798
Wlfr Ret Charges Amount
$7,720
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$28,249
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$12,526
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 10
Ins Carrier Name: AMERICAN MERITAGE LIFE
Filing Id
84037344347318
Form Id
93249321
Schedule A EIN
61-0921718
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2007-01-01
Schedule A Tax Period
20071231
Ins Carrier Name
AMERICAN MERITAGE LIFE
Ins Carrier EIN
59-0781901
Ins Carrier Naic Code
60534
Ins Contract Num
31992
Ins Prsn Covered End of year Count
13
Ins Policy From Date
2007-01-01
Ins Policy To Date
2007-12-31
Ins Broker Comm Total Amount
$725
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
CANCER/INTCNSIVE CARE
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
$4,833
Wlfr Acquis Cost Amount
$0
Row 11
Ins Carrier Name: HUMANA INSURANLE COMPANY
Filing Id
84037344347318
Form Id
93249319
Schedule A EIN
61-0921718
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2007-01-01
Schedule A Tax Period
20071231
Ins Carrier Name
HUMANA INSURANLE COMPANY
Ins Carrier EIN
39-1263773
Ins Carrier Naic Code
73288
Ins Contract Num
592753
Ins Prsn Covered End of year Count
289
Ins Policy From Date
2007-01-01
Ins Policy To Date
2007-12-31
Ins Broker Comm Total Amount
$36,888
Ins Broker Fees Total Amount
$125,610
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
ABCI
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
$364,023
Wlfr Acquis Cost Amount
$0
Row 12
Ins Carrier Name: AMERILAN HERITAGE LIFE
Filing Id
84037344347318
Form Id
93249323
Schedule A EIN
61-0921718
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2007-01-01
Schedule A Tax Period
20071231
Ins Carrier Name
AMERILAN HERITAGE LIFE
Ins Carrier EIN
59-0781901
Ins Carrier Naic Code
60534
Ins Contract Num
545S5
Ins Prsn Covered End of year Count
13
Ins Policy From Date
2007-01-01
Ins Policy To Date
2007-12-31
Ins Broker Comm Total Amount
$586
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
CANCERIINTENSIVE CARE
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
$3,905
Wlfr Acquis Cost Amount
$0

Schedule C

Schedule C Provider

Provider 1

Provider details

Source fields
Row 1
Filing Id
84037344347318
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060007
Provider 01 Name
HUMANA INSURANLE COMPANY
Provider 01 EIN
39-1263473
Provider 01 Position
CONTRACT ADMINISTRATOR
Provider 01 Relation
CONTRACTOR
Provider 01 Salary Amount
$4
Provider 01 Fees Amount
$125,610
Provider 01 Srvc Code
1213
Row 2
Filing Id
84037344347318
Page Id
3
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
7020378344347060007

Schedule C Provider

Provider 2

Provider details

Source fields
Row 3
Filing Id
84037344347318
Schedule C EIN
61-0921718
Schedule C Plan number
502
Schedule C Plan Year Begin Date
2007-01-01
Schedule C Tax Period
20071231
Provider Total Comp Paid Amount
$0