| Insurance contract or identification number | 5395960 |
| Number of Individuals Covered | 169 |
| Insurance policy start date | 2023-06-01 |
| Insurance policy end date | 2024-05-31 |
| Total amount of commissions paid to insurance broker | USD $5,816 |
| Total amount of fees paid to insurance company | USD $3,122 |
| Health Insurance Welfare Benefit | No |
| Dental Insurance Welfare Benefit | No |
| 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 | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS |
| Welfare Benefit Premiums Paid to Carrier | USD $52,665 |
| Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |