TOM FORD RETAIL LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN
Measure | Date | Value |
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2022: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 129 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 138 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 139 |
2021: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 122 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 124 |
2020: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 167 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 139 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 139 |
2019: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-02-01 | 252 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 274 |
Total of all active and inactive participants | 2019-02-01 | 274 |
2018: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-02-01 | 267 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 252 |
Total of all active and inactive participants | 2018-02-01 | 252 |
2017: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-02-01 | 281 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 267 |
Total of all active and inactive participants | 2017-02-01 | 267 |
2016: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-02-01 | 263 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 281 |
Total of all active and inactive participants | 2016-02-01 | 281 |
2015: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-02-01 | 223 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 263 |
Total of all active and inactive participants | 2015-02-01 | 263 |
2014: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-02-01 | 125 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 223 |
Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
Total of all active and inactive participants | 2014-02-01 | 223 |
2013: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-02-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 125 |
Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
Total of all active and inactive participants | 2013-02-01 | 125 |
Measure | Date | Value |
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2019 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2019 401k financial data |
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Total income from all sources (including contributions) | 2019-12-31 | $2,312,875 |
Total of all expenses incurred | 2019-12-31 | $2,312,875 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $2,312,875 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $2,312,875 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
Was this plan covered by a fidelity bond | 2019-12-31 | No |
If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Value of net income/loss | 2019-12-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,312,875 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
Contributions received in cash from employer | 2019-12-31 | $2,312,875 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
Did the plan have assets held for investment | 2019-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Qualified |
Accountancy firm name | 2019-12-31 | RSM US LLP |
Accountancy firm EIN | 2019-12-31 | 420714325 |
2018 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2018 401k financial data |
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Total income from all sources (including contributions) | 2018-01-31 | $2,076,986 |
Total of all expenses incurred | 2018-01-31 | $2,076,986 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-01-31 | $2,076,986 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-01-31 | $2,076,986 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-01-31 | No |
Was this plan covered by a fidelity bond | 2018-01-31 | No |
If this is an individual account plan, was there a blackout period | 2018-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2018-01-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-01-31 | No |
Value of net income/loss | 2018-01-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2018-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2018-01-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2018-01-31 | $2,076,986 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2018-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2018-01-31 | No |
Contributions received in cash from employer | 2018-01-31 | $2,076,986 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-01-31 | No |
Did the plan have assets held for investment | 2018-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2018-01-31 | Qualified |
Accountancy firm name | 2018-01-31 | RSM US LLP |
Accountancy firm EIN | 2018-01-31 | 420714325 |
2017 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2017 401k financial data |
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Total income from all sources (including contributions) | 2017-01-31 | $2,015,998 |
Total of all expenses incurred | 2017-01-31 | $2,015,998 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-01-31 | $2,015,998 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-01-31 | $2,015,998 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-01-31 | No |
Was this plan covered by a fidelity bond | 2017-01-31 | No |
If this is an individual account plan, was there a blackout period | 2017-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2017-01-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
Value of net income/loss | 2017-01-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2017-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2017-01-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2017-01-31 | $2,015,998 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2017-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2017-01-31 | No |
Contributions received in cash from employer | 2017-01-31 | $2,015,998 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-01-31 | No |
Did the plan have assets held for investment | 2017-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2017-01-31 | Qualified |
Accountancy firm name | 2017-01-31 | RSM US LLP |
Accountancy firm EIN | 2017-01-31 | 420714325 |
2016 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2016 401k financial data |
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Total income from all sources (including contributions) | 2016-01-31 | $1,705,997 |
Total of all expenses incurred | 2016-01-31 | $1,705,997 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-01-31 | $1,705,997 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-01-31 | $1,705,997 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-01-31 | No |
Was this plan covered by a fidelity bond | 2016-01-31 | No |
If this is an individual account plan, was there a blackout period | 2016-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2016-01-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-01-31 | No |
Value of net income/loss | 2016-01-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2016-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2016-01-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2016-01-31 | $1,705,997 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2016-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2016-01-31 | No |
Contributions received in cash from employer | 2016-01-31 | $1,705,997 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-01-31 | No |
Did the plan have assets held for investment | 2016-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2016-01-31 | Qualified |
Accountancy firm name | 2016-01-31 | RSM US LLP |
Accountancy firm EIN | 2016-01-31 | 420714325 |
2015 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2015 401k financial data |
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Total income from all sources (including contributions) | 2015-01-31 | $1,620,506 |
Total of all expenses incurred | 2015-01-31 | $1,620,506 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-01-31 | $1,620,506 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-01-31 | $1,620,506 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-01-31 | No |
Was this plan covered by a fidelity bond | 2015-01-31 | No |
If this is an individual account plan, was there a blackout period | 2015-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2015-01-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
Value of net income/loss | 2015-01-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-01-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2015-01-31 | $1,620,506 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2015-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2015-01-31 | No |
Contributions received in cash from employer | 2015-01-31 | $1,620,506 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-01-31 | No |
Did the plan have assets held for investment | 2015-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2015-01-31 | Qualified |
Accountancy firm name | 2015-01-31 | MCGLADREY LLP |
Accountancy firm EIN | 2015-01-31 | 420714325 |
2014 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2014 401k financial data |
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Total income from all sources (including contributions) | 2014-01-31 | $956,524 |
Total of all expenses incurred | 2014-01-31 | $956,524 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-01-31 | $956,524 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-01-31 | $956,524 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-01-31 | No |
Was this plan covered by a fidelity bond | 2014-01-31 | No |
If this is an individual account plan, was there a blackout period | 2014-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2014-01-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
Value of net income/loss | 2014-01-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-01-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2014-01-31 | $956,524 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2014-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2014-01-31 | No |
Contributions received in cash from employer | 2014-01-31 | $956,524 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-01-31 | No |
Did the plan have assets held for investment | 2014-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2014-01-31 | Qualified |
Accountancy firm name | 2014-01-31 | MCGLADREY LLP |
Accountancy firm EIN | 2014-01-31 | 420714325 |
2022: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Submission has been amended | No |
2022-01-01 | This submission is the final filing | No |
2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-01-01 | Plan is a collectively bargained plan | No |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Submission has been amended | No |
2021-01-01 | This submission is the final filing | No |
2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-01-01 | Plan is a collectively bargained plan | No |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Submission has been amended | No |
2020-01-01 | This submission is the final filing | No |
2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-01-01 | Plan is a collectively bargained plan | No |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2019 form 5500 responses |
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2019-02-01 | Type of plan entity | Single employer plan |
2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2019-02-01 | Plan funding arrangement – Insurance | Yes |
2019-02-01 | Plan benefit arrangement – Insurance | Yes |
2018: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2018 form 5500 responses |
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2018-02-01 | Type of plan entity | Single employer plan |
2018-02-01 | Plan funding arrangement – Insurance | Yes |
2018-02-01 | Plan benefit arrangement – Insurance | Yes |
2017: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2017 form 5500 responses |
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2017-02-01 | Type of plan entity | Single employer plan |
2017-02-01 | Plan funding arrangement – Insurance | Yes |
2017-02-01 | Plan benefit arrangement – Insurance | Yes |
2016: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2016 form 5500 responses |
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2016-02-01 | Type of plan entity | Single employer plan |
2016-02-01 | Plan funding arrangement – Insurance | Yes |
2016-02-01 | Plan benefit arrangement – Insurance | Yes |
2015: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2015 form 5500 responses |
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2015-02-01 | Type of plan entity | Single employer plan |
2015-02-01 | Plan funding arrangement – Insurance | Yes |
2015-02-01 | Plan benefit arrangement – Insurance | Yes |
2014: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2014 form 5500 responses |
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2014-02-01 | Type of plan entity | Single employer plan |
2014-02-01 | Plan funding arrangement – Insurance | Yes |
2014-02-01 | Plan benefit arrangement – Insurance | Yes |
2013: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2013 form 5500 responses |
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2013-02-01 | Type of plan entity | Single employer plan |
2013-02-01 | First time form 5500 has been submitted | Yes |
2013-02-01 | Plan funding arrangement – Insurance | Yes |
2013-02-01 | Plan benefit arrangement – Insurance | Yes |
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30031317 |
Policy instance | 3 |
Insurance contract or identification number | 30031317 | Number of Individuals Covered | 139 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,266 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,029 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 910744 |
Policy instance | 2 |
Insurance contract or identification number | 910744 | Number of Individuals Covered | 254 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $13,581 | Total amount of fees paid to insurance company | USD $4,019 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $104,300 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,922 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4019 | Additional information about fees paid to insurance broker | BONUS |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 242502 |
Policy instance | 1 |
Insurance contract or identification number | 242502 | Number of Individuals Covered | 260 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $91,479 | Total amount of fees paid to insurance company | USD $24,220 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,056,929 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $91,479 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 24220 | Additional information about fees paid to insurance broker | OVERRIDE |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30031317 |
Policy instance | 3 |
Insurance contract or identification number | 30031317 | Number of Individuals Covered | 146 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,108 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $946 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0910744 |
Policy instance | 2 |
Insurance contract or identification number | 0910744 | Number of Individuals Covered | 228 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $12,109 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $96,574 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,063 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0242502 |
Policy instance | 1 |
Insurance contract or identification number | 0242502 | Number of Individuals Covered | 231 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $103,573 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,025,326 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $81,593 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | OVERRIDES |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30031317 |
Policy instance | 3 |
Insurance contract or identification number | 30031317 | Number of Individuals Covered | 155 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,439 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,439 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0910744 |
Policy instance | 2 |
Insurance contract or identification number | 0910744 | Number of Individuals Covered | 153 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $13,166 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $109,721 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,680 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0242502 |
Policy instance | 1 |
Insurance contract or identification number | 0242502 | Number of Individuals Covered | 161 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $84,224 | Total amount of fees paid to insurance company | USD $25,662 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,275,681 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $84,224 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 25662 | Additional information about fees paid to insurance broker | OVERRIDES |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 274 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $89,022 | Total amount of fees paid to insurance company | USD $27,370 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,312,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $89,022 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 27370 |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 252 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $84,409 | Total amount of fees paid to insurance company | USD $26,810 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,043,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $84,409 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 26810 |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 267 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $83,139 | Total amount of fees paid to insurance company | USD $25,900 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,076,986 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $83,139 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 25900 | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 262 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $66,319 | Total amount of fees paid to insurance company | USD $22,498 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,705,997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $66,319 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 22498 | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 223 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $63,456 | Total amount of fees paid to insurance company | USD $22,750 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,620,506 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63,456 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 22750 | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
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OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | TF7885 |
Policy instance | 1 |
Insurance contract or identification number | TF7885 | Number of Individuals Covered | 208 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $37,656 | Total amount of fees paid to insurance company | USD $16,030 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $956,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,656 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 16030 | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
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