FLEETWASH, INC. has sponsored the creation of one or more 401k plans.
Additional information about FLEETWASH, INC.
Submission information for form 5500 for 401k plan FLEETWASH EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2021: FLEETWASH EMPLOYEE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 288 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 243 |
| Total of all active and inactive participants | 2021-02-01 | 243 |
| Total participants | 2021-02-01 | 243 |
| 2020: FLEETWASH EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 316 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 288 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 288 |
| Total participants | 2020-02-01 | 288 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-02-01 | 0 |
| 2019: FLEETWASH EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 380 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 316 |
| Total of all active and inactive participants | 2019-02-01 | 316 |
| Total participants | 2019-02-01 | 316 |
| 2018: FLEETWASH EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 366 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 380 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
| Total of all active and inactive participants | 2018-02-01 | 380 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-02-01 | 0 |
| Total participants | 2018-02-01 | 380 |
| Number of participants with account balances | 2018-02-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-02-01 | 0 |
| 2017: FLEETWASH EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 366 |
| Total of all active and inactive participants | 2017-02-01 | 366 |
| Total participants | 2017-02-01 | 366 |
| 2016: FLEETWASH EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 298 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 349 |
| Total of all active and inactive participants | 2016-02-01 | 349 |
| Total participants | 2016-02-01 | 349 |
| 2015: FLEETWASH EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 284 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 298 |
| Total of all active and inactive participants | 2015-02-01 | 298 |
| Total participants | 2015-02-01 | 298 |
| 2014: FLEETWASH EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 284 |
| Total of all active and inactive participants | 2014-02-01 | 284 |
| Total participants | 2014-02-01 | 284 |
| 2013: FLEETWASH EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 168 |
| Total of all active and inactive participants | 2013-02-01 | 168 |
| Total participants | 2013-02-01 | 168 |
| 2012: FLEETWASH EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 156 |
| Total of all active and inactive participants | 2012-02-01 | 156 |
| Total participants | 2012-02-01 | 156 |
| 2011: FLEETWASH EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 160 |
| Total of all active and inactive participants | 2011-02-01 | 160 |
| Total participants | 2011-02-01 | 160 |
| 2010: FLEETWASH EMPLOYEE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 167 |
| Total of all active and inactive participants | 2010-02-01 | 167 |
| Total participants | 2010-02-01 | 167 |
| 2009: FLEETWASH EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 160 |
| Total of all active and inactive participants | 2009-02-01 | 160 |
| Total participants | 2009-02-01 | 160 |
| 2021: FLEETWASH EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FLEETWASH EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: FLEETWASH EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: FLEETWASH EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: FLEETWASH EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: FLEETWASH EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: FLEETWASH EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: FLEETWASH EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: FLEETWASH EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: FLEETWASH EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: FLEETWASH EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: FLEETWASH EMPLOYEE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: FLEETWASH EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HEALTHCARE DENTAL, INC. (National Association of Insurance Commissioners NAIC id number: 11146 ) |
| Policy contract number | 86583 |
| Policy instance | 5 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $42 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) |
| Policy contract number | 86583 |
| Policy instance | 4 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $2,667 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,667 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMNY6X00-7L33 |
| Policy instance | 3 |
| Insurance contract or identification number | GMNY6X00-7L33 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 315435T |
| Policy instance | 2 |
| Insurance contract or identification number | 315435T | | Number of Individuals Covered | 130 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,686 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $60,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,686 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86583 |
| Policy instance | 1 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $4,372 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,372 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86583 |
| Policy instance | 1 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 288 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $44,972 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,029,155 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,972 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMNY6X00-7L33 |
| Policy instance | 3 |
| Insurance contract or identification number | GMNY6X00-7L33 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $1,215 | | Total amount of fees paid to insurance company | USD $820 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,215 | | Amount paid for insurance broker fees | 820 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) |
| Policy contract number | 86583 |
| Policy instance | 4 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $2,711 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,711 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HEALTHCARE DENTAL, INC. (National Association of Insurance Commissioners NAIC id number: 11146 ) |
| Policy contract number | 86583 |
| Policy instance | 5 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $75 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 315435T |
| Policy instance | 2 |
| Insurance contract or identification number | 315435T | | Number of Individuals Covered | 152 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,618 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $24,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,618 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| HEALTHCARE DENTAL, INC. (National Association of Insurance Commissioners NAIC id number: 11146 ) |
| Policy contract number | 86583 |
| Policy instance | 5 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $73 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,899 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMNY6X00-7L33 |
| Policy instance | 3 |
| Insurance contract or identification number | GMNY6X00-7L33 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $1,047 | | Total amount of fees paid to insurance company | USD $598 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,047 | | Amount paid for insurance broker fees | 598 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 315435T |
| Policy instance | 2 |
| Insurance contract or identification number | 315435T | | Number of Individuals Covered | 130 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,432 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $21,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,432 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86583 |
| Policy instance | 1 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 316 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $42,825 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,919,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,825 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE/AGENT BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) |
| Policy contract number | 86583 |
| Policy instance | 4 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,849 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,849 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 |
|
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) |
| Policy contract number | 86583 |
| Policy instance | 4 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $2,384 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $2,384 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMNY6X00-7L33 |
| Policy instance | 3 |
| Insurance contract or identification number | GMNY6X00-7L33 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-10-01 | | Total amount of commissions paid to insurance broker | USD $331 | | Total amount of fees paid to insurance company | USD $325 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $331 | | Amount paid for insurance broker fees | 325 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 315435T |
| Policy instance | 2 |
| Insurance contract or identification number | 315435T | | Number of Individuals Covered | 140 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,419 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $20,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,419 | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86583 |
| Policy instance | 1 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 380 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $54,041 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,024,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $54,041 | | Insurance broker organization code? | 5 |
|
| HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 ) |
| Policy contract number | 86583 |
| Policy instance | 4 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $1,558 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,558 | | Insurance broker organization code? | 5 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMNY6X00-7L33 |
| Policy instance | 3 |
| Insurance contract or identification number | GMNY6X00-7L33 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-10-01 | | Total amount of commissions paid to insurance broker | USD $241 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $241 | | Insurance broker organization code? | 3 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 315435T |
| Policy instance | 2 |
| Insurance contract or identification number | 315435T | | Number of Individuals Covered | 140 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,459 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $20,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,459 | | Insurance broker organization code? | 3 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86583 |
| Policy instance | 1 |
| Insurance contract or identification number | 86583 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $46,141 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,590,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $46,141 | | Insurance broker organization code? | 5 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS, LLC |
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