GOODWILL INDUSTRIES-BIG BEND, INC. has sponsored the creation of one or more 401k plans.
Additional information about GOODWILL INDUSTRIES-BIG BEND, INC.
Submission information for form 5500 for 401k plan GOODWILL INDUSTRIES - BIG BEND, INC.
401k plan membership statisitcs for GOODWILL INDUSTRIES - BIG BEND, INC.
| Measure | Date | Value |
|---|
| 2021: GOODWILL INDUSTRIES - BIG BEND, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 146 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 146 |
| 2020: GOODWILL INDUSTRIES - BIG BEND, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 293 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 357 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 364 |
| 2019: GOODWILL INDUSTRIES - BIG BEND, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 293 |
| Total of all active and inactive participants | 2019-07-01 | 293 |
| 2018: GOODWILL INDUSTRIES - BIG BEND, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 368 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 339 |
| Total of all active and inactive participants | 2018-07-01 | 339 |
| 2017: GOODWILL INDUSTRIES - BIG BEND, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 368 |
| Total of all active and inactive participants | 2017-07-01 | 368 |
| 2016: GOODWILL INDUSTRIES - BIG BEND, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 359 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 422 |
| Total of all active and inactive participants | 2016-07-01 | 422 |
| 2015: GOODWILL INDUSTRIES - BIG BEND, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 359 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 330 |
| Total of all active and inactive participants | 2015-07-01 | 330 |
| 2014: GOODWILL INDUSTRIES - BIG BEND, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 359 |
| Total of all active and inactive participants | 2014-07-01 | 359 |
| 2013: GOODWILL INDUSTRIES - BIG BEND, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 341 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 311 |
| Total of all active and inactive participants | 2013-07-01 | 311 |
| 2012: GOODWILL INDUSTRIES - BIG BEND, INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 355 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 341 |
| Total of all active and inactive participants | 2012-07-01 | 341 |
| 2011: GOODWILL INDUSTRIES - BIG BEND, INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 355 |
| Total of all active and inactive participants | 2011-07-01 | 355 |
| 2010: GOODWILL INDUSTRIES - BIG BEND, INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 285 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 344 |
| Total of all active and inactive participants | 2010-07-01 | 344 |
| 2009: GOODWILL INDUSTRIES - BIG BEND, INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 285 |
| Total of all active and inactive participants | 2009-07-01 | 285 |
| Total participants | 2009-07-01 | 285 |
| Measure | Date | Value |
|---|
| 2022 : GOODWILL INDUSTRIES - BIG BEND, INC. 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $279,751 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $0 |
| Total income from all sources (including contributions) | 2022-06-30 | $1,185,361 |
| Total loss/gain on sale of assets | 2022-06-30 | $0 |
| Total of all expenses incurred | 2022-06-30 | $1,311,157 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $1,210,561 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $1,185,149 |
| Value of total assets at end of year | 2022-06-30 | $153,955 |
| Value of total assets at beginning of year | 2022-06-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $100,596 |
| Total interest from all sources | 2022-06-30 | $212 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Administrative expenses professional fees incurred | 2022-06-30 | $100,596 |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Contributions received from participants | 2022-06-30 | $26,890 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-06-30 | $145,612 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-06-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $-125,796 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $-125,796 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-06-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-06-30 | $8,343 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-06-30 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-06-30 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-06-30 | $212 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $253,981 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-06-30 | No |
| Contributions received in cash from employer | 2022-06-30 | $1,158,259 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-06-30 | $956,580 |
| Liabilities. Value of benefit claims payable at end of year | 2022-06-30 | $279,751 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-06-30 | $0 |
| Did the plan have assets held for investment | 2022-06-30 | Yes |
| 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 | 2022-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | LAW REDD CRONA & MUNROE, P.A. |
| Accountancy firm EIN | 2022-06-30 | 592221664 |
| 2021: GOODWILL INDUSTRIES - BIG BEND, INC. 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: GOODWILL INDUSTRIES - BIG BEND, INC. 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | No |
| 2020-07-01 | This submission is the final filing | No |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-07-01 | Plan is a collectively bargained plan | No |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: GOODWILL INDUSTRIES - BIG BEND, INC. 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Submission has been amended | No |
| 2019-07-01 | This submission is the final filing | No |
| 2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-07-01 | Plan is a collectively bargained plan | No |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GOODWILL INDUSTRIES - BIG BEND, INC. 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GOODWILL INDUSTRIES - BIG BEND, INC. 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GOODWILL INDUSTRIES - BIG BEND, INC. 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GOODWILL INDUSTRIES - BIG BEND, INC. 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GOODWILL INDUSTRIES - BIG BEND, INC. 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GOODWILL INDUSTRIES - BIG BEND, INC. 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GOODWILL INDUSTRIES - BIG BEND, INC. 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GOODWILL INDUSTRIES - BIG BEND, INC. 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: GOODWILL INDUSTRIES - BIG BEND, INC. 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GOODWILL INDUSTRIES - BIG BEND, INC. 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | No |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 31000242 |
| Policy instance | 1 |
| Insurance contract or identification number | 31000242 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | 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 | 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 $253,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM09074000 |
| Policy instance | 4 |
| Insurance contract or identification number | DM09074000 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 $10,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00066 |
| Policy instance | 3 |
| Insurance contract or identification number | 00066 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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? | Yes | | 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 $423,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00448982 |
| Policy instance | 2 |
| Insurance contract or identification number | 00448982 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $8,026 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $146,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 8026 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 42774 |
| Policy instance | 1 |
| Insurance contract or identification number | 42774 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | DM9074001 |
| Policy instance | 4 |
| Insurance contract or identification number | DM9074001 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00066 |
| Policy instance | 3 |
| Insurance contract or identification number | 00066 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00448982 |
| Policy instance | 2 |
| Insurance contract or identification number | 00448982 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $6,587 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | 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 $138,342 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,587 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 42774 |
| Policy instance | 1 |
| Insurance contract or identification number | 42774 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 09074001 |
| Policy instance | 4 |
| Insurance contract or identification number | 09074001 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,097 | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00066 |
| Policy instance | 3 |
| Insurance contract or identification number | 00066 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00448982 |
| Policy instance | 2 |
| Insurance contract or identification number | 00448982 | | Number of Individuals Covered | 339 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $8,103 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Amount paid for insurance broker fees | 8103 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 42774 |
| Policy instance | 1 |
| Insurance contract or identification number | 42774 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
| Policy contract number | 09074001 |
| Policy instance | 4 |
| Insurance contract or identification number | 09074001 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00066 |
| Policy instance | 3 |
| Insurance contract or identification number | 00066 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00448982 |
| Policy instance | 2 |
| Insurance contract or identification number | 00448982 | | Number of Individuals Covered | 368 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 42774 |
| Policy instance | 1 |
| Insurance contract or identification number | 42774 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
