| Insurance contract or identification number | 30055396 |
| Number of Individuals Covered | 240 |
| Insurance policy start date | 2022-01-01 |
| Insurance policy end date | 2022-12-31 |
| Total amount of commissions paid to insurance broker | USD $4,041 |
| Total amount of fees paid to insurance company | USD $0 |
| 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 $44,345 |
| Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |