PREMIER CUSTOM-BUILT, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC.
401k plan membership statisitcs for HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC.
| Measure | Date | Value |
|---|
| 2022: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 93 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| 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 | 93 |
| 2021: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 92 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| 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 | 92 |
| 2020: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 84 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 85 |
| 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 | 85 |
| 2019: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 82 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 82 |
| 2018: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 81 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 92 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 92 |
| 2017: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 81 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 81 |
| 2016: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 82 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 89 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 90 |
| 2015: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 82 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 82 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 82 |
| Measure | Date | Value |
|---|
| 2018 : HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2018 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2018-12-31 | $102,249 |
| Total income from all sources | 2018-12-31 | $87,463 |
| Total plan assets at end of year | 2018-12-31 | $0 |
| Total plan assets at beginning of year | 2018-12-31 | $14,786 |
| Other income received | 2018-12-31 | $85,005 |
| Net income (gross income less expenses) | 2018-12-31 | $87,463 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-87,463 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $2,458 |
| 2017 : HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $102,249 |
| Total plan liabilities at beginning of year | 2017-12-31 | $94,209 |
| Total income from all sources | 2017-12-31 | $1,103,197 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,113,721 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $725,670 |
| Total plan assets at end of year | 2017-12-31 | $14,786 |
| Total plan assets at beginning of year | 2017-12-31 | $17,270 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $330,964 |
| Other income received | 2017-12-31 | $55 |
| Net income (gross income less expenses) | 2017-12-31 | $-10,524 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $-87,463 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-76,939 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $1,103,142 |
| Value of corrective distributions | 2017-12-31 | $8,652 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $48,435 |
| 2016 : HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $94,209 |
| Total plan liabilities at beginning of year | 2016-12-31 | $60,075 |
| Total income from all sources | 2016-12-31 | $894,924 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $998,225 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $671,393 |
| Total plan assets at end of year | 2016-12-31 | $17,270 |
| Total plan assets at beginning of year | 2016-12-31 | $86,437 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $239,000 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $263,486 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $582 |
| Other income received | 2016-12-31 | $92 |
| Net income (gross income less expenses) | 2016-12-31 | $-103,301 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $-76,939 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $26,362 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $655,250 |
| Value of corrective distributions | 2016-12-31 | $12,112 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $51,234 |
| 2015 : HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $60,075 |
| Total plan liabilities at beginning of year | 2015-12-31 | $0 |
| Total income from all sources | 2015-12-31 | $881,217 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $854,855 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $532,117 |
| Total plan assets at end of year | 2015-12-31 | $86,437 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $212,892 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $273,901 |
| Contributions received from other sources (not participants or employers) | 2015-12-31 | $0 |
| Other income received | 2015-12-31 | $60 |
| Net income (gross income less expenses) | 2015-12-31 | $26,362 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $26,362 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $668,265 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $48,837 |
| 2022: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: HEALTH PLAN FOR THE EMPLOYEES OF PREMIER CUSTOM-BUILT, INC. 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | First time form 5500 has been submitted | Yes |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05948981 |
| Policy instance | 2 |
| Insurance contract or identification number | TS05948981 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,540 | | Total amount of fees paid to insurance company | USD $322 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,257 | | Amount paid for insurance broker fees | 322 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 1 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,047 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $35,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,047 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 08L4815 |
| Policy instance | 3 |
| Insurance contract or identification number | 08L4815 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $51,216 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $957,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,345 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05948981 |
| Policy instance | 2 |
| Insurance contract or identification number | TS05948981 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,800 | | Total amount of fees paid to insurance company | USD $732 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,431 | | Amount paid for insurance broker fees | 732 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 1 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,031 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $34,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,031 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5948981 |
| Policy instance | 2 |
| Insurance contract or identification number | 5948981 | | Number of Individuals Covered | 320 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,931 | | Total amount of fees paid to insurance company | USD $30 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,717 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,474 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 30 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 267013 |
| Policy instance | 3 |
| Insurance contract or identification number | 267013 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $36,828 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,084,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,828 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 1 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,967 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $34,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,967 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5948981 |
| Policy instance | 3 |
| Insurance contract or identification number | 5948981 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,259 | | Total amount of fees paid to insurance company | USD $415 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,422 | | Amount paid for insurance broker fees | 415 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 1 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,931 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $32,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,931 | | Insurance broker organization code? | 3 |
|
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00531385 |
| Policy instance | 2 |
| Insurance contract or identification number | 00531385 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $22,632 | | Welfare Benefit Premiums Paid to Carrier | USD $1,074,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,632 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5948981 |
| Policy instance | 3 |
| Insurance contract or identification number | 5948981 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,747 | | Total amount of fees paid to insurance company | USD $2,931 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,381 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,091 | | Amount paid for insurance broker fees | 2931 | | Insurance broker organization code? | 3 |
|
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00531385 |
| Policy instance | 2 |
| Insurance contract or identification number | 00531385 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $24,264 | | Welfare Benefit Premiums Paid to Carrier | USD $1,134,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,264 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 1 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,994 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,994 | | Insurance broker organization code? | 3 |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00615524 |
| Policy instance | 2 |
| Insurance contract or identification number | G 00615524 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,722 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,722 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENECON GROUP |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| Insurance contract or identification number | VERIS | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $283,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1032037 |
| Policy instance | 2 |
| Insurance contract or identification number | 1032037 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,343 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 $74,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,343 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NONE | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENECON GROUP |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | No | | 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 | 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 $194,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
