Insurance contract or identification number | 21928 |
Number of Individuals Covered | 284 |
Insurance policy start date | 2022-01-01 |
Insurance policy end date | 2022-12-31 |
Total amount of commissions paid to insurance broker | USD $21,262 |
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 | Yes |
Life Insurance Welfare Benefit | Yes |
Temporary Disability Insurance Welfare Benefit | Yes |
Long Term Disability Insurance Welfare Benefit | Yes |
Unemployment Insurance Welfare Benefit | No |
Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT |
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 $181,874 |
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
Commission paid to Insurance Broker | USD $14,757 |
Insurance broker organization code? | 3 |