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I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 401k Plan overview

Plan NameI.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN
Plan identification number 501

I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TRUSTEES OF I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN has sponsored the creation of one or more 401k plans.

Company Name:TRUSTEES OF I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN
Employer identification number (EIN):596134297
NAIC Classification:238210
NAIC Description:Electrical Contractors and Other Wiring Installation Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01ZAC CASSIDY2023-07-13 JAMES STUBBLEFIELD2023-07-13
5012021-01-01ZAC CASSIDY2022-07-14 JONATHAN BORDEN2022-07-14
5012020-01-01ZAC CASSIDY2021-06-14 J.R. BORDEN2021-06-15

Plan Statistics for I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN

401k plan membership statisitcs for I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN

Measure Date Value
2022: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01849
Total number of active participants reported on line 7a of the Form 55002022-01-01829
Number of retired or separated participants receiving benefits2022-01-0112
Total of all active and inactive participants2022-01-01841
Number of employers contributing to the scheme2022-01-0166
2021: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01831
Total number of active participants reported on line 7a of the Form 55002021-01-01838
Number of retired or separated participants receiving benefits2021-01-0111
Total of all active and inactive participants2021-01-01849
Number of employers contributing to the scheme2021-01-0165
2020: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01787
Total number of active participants reported on line 7a of the Form 55002020-01-01818
Number of retired or separated participants receiving benefits2020-01-0113
Total of all active and inactive participants2020-01-01831
Number of employers contributing to the scheme2020-01-0147

Financial Data on I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN

Measure Date Value
2022 : I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-108,944
Total unrealized appreciation/depreciation of assets2022-12-31$-108,944
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$41,996
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$50,986
Total income from all sources (including contributions)2022-12-31$10,397,996
Total loss/gain on sale of assets2022-12-31$6,373
Total of all expenses incurred2022-12-31$10,542,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$10,171,901
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$10,451,712
Value of total assets at end of year2022-12-31$5,264,754
Value of total assets at beginning of year2022-12-31$5,418,297
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$370,648
Total interest from all sources2022-12-31$38,626
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$162,098
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$137,669
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$13,348
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$8,275
Other income not declared elsewhere2022-12-31$10,229
Administrative expenses (other) incurred2022-12-31$66,377
Liabilities. Value of operating payables at end of year2022-12-31$41,996
Liabilities. Value of operating payables at beginning of year2022-12-31$50,986
Total non interest bearing cash at end of year2022-12-31$1,789,479
Total non interest bearing cash at beginning of year2022-12-31$2,090,338
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-144,553
Value of net assets at end of year (total assets less liabilities)2022-12-31$5,222,758
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$5,367,311
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$9,626
Income. Interest from US Government securities2022-12-31$18,877
Income. Interest from corporate debt instruments2022-12-31$18,890
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$8,531
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$13,632
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$13,632
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$859
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$10,115,506
Asset value of US Government securities at end of year2022-12-31$877,944
Asset value of US Government securities at beginning of year2022-12-31$1,191,284
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$10,314,043
Employer contributions (assets) at end of year2022-12-31$1,215,613
Employer contributions (assets) at beginning of year2022-12-31$1,304,352
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$56,395
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$1,359,839
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$810,416
Contract administrator fees2022-12-31$132,547
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$3,331,988
Aggregate carrying amount (costs) on sale of assets2022-12-31$3,325,615
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31LEGACY PROFESSIONALS LLP
Accountancy firm EIN2022-12-31320043599
2021 : I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$-28,804
Total unrealized appreciation/depreciation of assets2021-12-31$-28,804
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$50,986
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$29,637
Total income from all sources (including contributions)2021-12-31$10,550,879
Total loss/gain on sale of assets2021-12-31$-5,484
Total of all expenses incurred2021-12-31$9,160,354
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$8,795,028
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$10,489,584
Value of total assets at end of year2021-12-31$5,418,297
Value of total assets at beginning of year2021-12-31$4,006,423
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$365,326
Total interest from all sources2021-12-31$26,396
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$156,957
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$109,041
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$8,275
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$5,440
Other income not declared elsewhere2021-12-31$69,187
Administrative expenses (other) incurred2021-12-31$60,006
Liabilities. Value of operating payables at end of year2021-12-31$50,986
Liabilities. Value of operating payables at beginning of year2021-12-31$29,637
Total non interest bearing cash at end of year2021-12-31$2,090,338
Total non interest bearing cash at beginning of year2021-12-31$1,718,856
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,390,525
Value of net assets at end of year (total assets less liabilities)2021-12-31$5,367,311
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,976,786
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$6,244
Income. Interest from US Government securities2021-12-31$15,727
Income. Interest from corporate debt instruments2021-12-31$10,661
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$13,632
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$6,774
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$6,774
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$8
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$8,728,483
Asset value of US Government securities at end of year2021-12-31$1,191,284
Asset value of US Government securities at beginning of year2021-12-31$771,627
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$10,380,543
Employer contributions (assets) at end of year2021-12-31$1,304,352
Employer contributions (assets) at beginning of year2021-12-31$1,155,740
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$66,545
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$810,416
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$347,986
Contract administrator fees2021-12-31$142,119
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$557,710
Aggregate carrying amount (costs) on sale of assets2021-12-31$563,194
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31LEGACY PROFESSIONALS LLP
Accountancy firm EIN2021-12-31320043599
2020 : I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$7,667
Total unrealized appreciation/depreciation of assets2020-12-31$7,667
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$29,637
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,151,475
Total income from all sources (including contributions)2020-12-31$10,713,142
Total loss/gain on sale of assets2020-12-31$3,460
Total of all expenses incurred2020-12-31$9,516,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$9,139,891
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$10,775,787
Value of total assets at end of year2020-12-31$4,006,423
Value of total assets at beginning of year2020-12-31$3,931,328
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$376,318
Total interest from all sources2020-12-31$21,574
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$154,008
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$97,329
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$115,069
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$5,440
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$101,501
Administrative expenses (other) incurred2020-12-31$70,482
Liabilities. Value of operating payables at end of year2020-12-31$29,637
Liabilities. Value of operating payables at beginning of year2020-12-31$71,475
Total non interest bearing cash at end of year2020-12-31$1,718,856
Total non interest bearing cash at beginning of year2020-12-31$1,145,075
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,196,933
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,976,786
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,779,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$4,608
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$319,725
Income. Interest from US Government securities2020-12-31$11,023
Income. Interest from corporate debt instruments2020-12-31$10,501
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$6,774
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$7,588
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$7,588
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$50
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$8,988,830
Asset value of US Government securities at end of year2020-12-31$771,627
Asset value of US Government securities at beginning of year2020-12-31$403,580
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$-95,346
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$10,678,458
Employer contributions (assets) at end of year2020-12-31$1,155,740
Employer contributions (assets) at beginning of year2020-12-31$1,495,528
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$35,992
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$347,986
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$458,331
Contract administrator fees2020-12-31$147,220
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$1,080,000
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$956,946
Aggregate carrying amount (costs) on sale of assets2020-12-31$953,486
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31LEGACY PROFESSIONALS LLP
Accountancy firm EIN2020-12-31320043599

Form 5500 Responses for I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN

2022: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulti-employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulti-employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: I.B.E.W. LOCAL 728 FAMILY HEALTHCARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulti-employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberAWF30000002
Policy instance 3
Insurance contract or identification numberAWF30000002
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $874
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $10,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $526
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0100504H0002A
Policy instance 2
Insurance contract or identification numberMZ0100504H0002A
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,455
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,637
Insurance broker organization code?5
Amount paid for insurance broker fees0
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0919555
Policy instance 1
Insurance contract or identification number0919555
Number of Individuals Covered2190
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,373
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,056,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,373
Insurance broker organization code?3
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0100504H0002A
Policy instance 3
Insurance contract or identification numberMZ0100504H0002A
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,209
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,806
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0919555
Policy instance 2
Insurance contract or identification number0919555
Number of Individuals Covered2178
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $20,646
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,456,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,646
Insurance broker organization code?3
ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberAWF30000002
Policy instance 1
Insurance contract or identification numberAWF30000002
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,493
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $17,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $912
Insurance broker organization code?5
COMPANION LIFE INSURANCE DENTAL (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract numberAWF30000002
Policy instance 4
Insurance contract or identification numberAWF30000002
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $817
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $609
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0100504H0002A
Policy instance 3
Insurance contract or identification numberMZ0100504H0002A
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,209
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,806
Insurance broker organization code?5
ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberAWF30000002
Policy instance 2
Insurance contract or identification numberAWF30000002
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $692
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $11,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $373
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0919555
Policy instance 1
Insurance contract or identification number0919555
Number of Individuals Covered1480
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,504
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,166,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,504
Insurance broker organization code?3

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