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WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 401k Plan overview

Plan NameWEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN
Plan identification number 507

WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

WEST SIDE COMMUNITY HEALTH SERVICES has sponsored the creation of one or more 401k plans.

Company Name:WEST SIDE COMMUNITY HEALTH SERVICES
Employer identification number (EIN):237156236
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072020-01-01CHRISTIE JANSEN2022-05-06
5072019-10-01CHRISTIE JANSEN2022-05-06
5072018-10-01CHRISTIE JANSEN2022-05-06
5072017-10-01CHRISTIE JANSEN2022-05-06
5072016-10-01BLAKE DARSOW
5072015-10-01BLAKE DARSOW
5072014-10-01BLAKE DARSOW
5072013-10-01BLAKE DARSOW
5072012-10-01BLAKE DARSOW
5072011-10-01BLAKE DARSOW
5072010-10-01BLAKE DARSOW
5072009-10-01BLAKE DARSOW
5072008-10-01BLAKE DARSOW
5072007-10-01BLAKE DARSOW
5072006-10-01BLAKE DARSOW
5072005-10-01BLAKE DARSOW
5072004-10-01BLAKE DARSOW
5072003-10-01BLAKE DARSOW
5072002-10-01BLAKE DARSOW
5072001-10-01BLAKE DARSOW
5072000-10-01BLAKE DARSOW
5071999-10-01BLAKE DARSOW

Plan Statistics for WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN

401k plan membership statisitcs for WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN

Measure Date Value
2020: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01333
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-010
Number of employers contributing to the scheme2020-01-010
2019: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01338
Total number of active participants reported on line 7a of the Form 55002019-10-01333
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01333
Number of employers contributing to the scheme2019-10-010
2018: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01322
Total number of active participants reported on line 7a of the Form 55002018-10-01338
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01338
Number of employers contributing to the scheme2018-10-010
2017: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01299
Total number of active participants reported on line 7a of the Form 55002017-10-01322
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01322
Number of employers contributing to the scheme2017-10-010
2016: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01131
Total number of active participants reported on line 7a of the Form 55002016-10-01299
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01299
Total participants2016-10-01299
2015: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01105
Total number of active participants reported on line 7a of the Form 55002015-10-01131
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01131
2014: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01178
Total number of active participants reported on line 7a of the Form 55002014-10-01105
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01105
2013: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01163
Total number of active participants reported on line 7a of the Form 55002013-10-01178
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01178
2012: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01170
Total number of active participants reported on line 7a of the Form 55002012-10-01163
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01163
2011: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01184
Total number of active participants reported on line 7a of the Form 55002011-10-01170
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01170
2010: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01179
Total number of active participants reported on line 7a of the Form 55002010-10-01184
Number of retired or separated participants receiving benefits2010-10-010
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01184
2009: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01179
Total number of active participants reported on line 7a of the Form 55002009-10-01179
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01179
2008: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year2008-10-01179
Total number of active participants reported on line 7a of the Form 55002008-10-01179
Number of retired or separated participants receiving benefits2008-10-010
Number of other retired or separated participants entitled to future benefits2008-10-010
Total of all active and inactive participants2008-10-01179
2007: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2007 401k membership
Total participants, beginning-of-year2007-10-01179
Total number of active participants reported on line 7a of the Form 55002007-10-01179
Number of retired or separated participants receiving benefits2007-10-010
Number of other retired or separated participants entitled to future benefits2007-10-010
Total of all active and inactive participants2007-10-01179
2006: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2006 401k membership
Total participants, beginning-of-year2006-10-01179
Total number of active participants reported on line 7a of the Form 55002006-10-01179
Number of retired or separated participants receiving benefits2006-10-010
Number of other retired or separated participants entitled to future benefits2006-10-010
Total of all active and inactive participants2006-10-01179
2005: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2005 401k membership
Total participants, beginning-of-year2005-10-01179
Total number of active participants reported on line 7a of the Form 55002005-10-01179
Number of retired or separated participants receiving benefits2005-10-010
Number of other retired or separated participants entitled to future benefits2005-10-010
Total of all active and inactive participants2005-10-01179
2004: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2004 401k membership
Total participants, beginning-of-year2004-10-01179
Total number of active participants reported on line 7a of the Form 55002004-10-01179
Number of retired or separated participants receiving benefits2004-10-010
Number of other retired or separated participants entitled to future benefits2004-10-010
Total of all active and inactive participants2004-10-01179
2003: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2003 401k membership
Total participants, beginning-of-year2003-10-01179
Total number of active participants reported on line 7a of the Form 55002003-10-01179
Number of retired or separated participants receiving benefits2003-10-010
Number of other retired or separated participants entitled to future benefits2003-10-010
Total of all active and inactive participants2003-10-01179
2002: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2002 401k membership
Total participants, beginning-of-year2002-10-01179
Total number of active participants reported on line 7a of the Form 55002002-10-01179
Number of retired or separated participants receiving benefits2002-10-010
Number of other retired or separated participants entitled to future benefits2002-10-010
Total of all active and inactive participants2002-10-01179
2001: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2001 401k membership
Total participants, beginning-of-year2001-10-01179
Total number of active participants reported on line 7a of the Form 55002001-10-01179
Number of retired or separated participants receiving benefits2001-10-010
Number of other retired or separated participants entitled to future benefits2001-10-010
Total of all active and inactive participants2001-10-01179
2000: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2000 401k membership
Total participants, beginning-of-year2000-10-01179
Total number of active participants reported on line 7a of the Form 55002000-10-01179
Number of retired or separated participants receiving benefits2000-10-010
Number of other retired or separated participants entitled to future benefits2000-10-010
Total of all active and inactive participants2000-10-01179
1999: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 1999 401k membership
Total participants, beginning-of-year1999-10-01179
Total number of active participants reported on line 7a of the Form 55001999-10-01179
Number of retired or separated participants receiving benefits1999-10-010
Number of other retired or separated participants entitled to future benefits1999-10-010
Total of all active and inactive participants1999-10-01179

Form 5500 Responses for WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN

2020: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes
2018: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – InsuranceYes
2017: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – InsuranceYes
2016: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2010: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes
2008: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo
2008-10-01Plan funding arrangement – InsuranceYes
2008-10-01Plan benefit arrangement – InsuranceYes
2007: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2007 form 5500 responses
2007-10-01Type of plan entitySingle employer plan
2007-10-01Submission has been amendedNo
2007-10-01This submission is the final filingNo
2007-10-01This return/report is a short plan year return/report (less than 12 months)No
2007-10-01Plan is a collectively bargained planNo
2007-10-01Plan funding arrangement – InsuranceYes
2007-10-01Plan benefit arrangement – InsuranceYes
2006: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2006 form 5500 responses
2006-10-01Type of plan entitySingle employer plan
2006-10-01Submission has been amendedNo
2006-10-01This submission is the final filingNo
2006-10-01This return/report is a short plan year return/report (less than 12 months)No
2006-10-01Plan is a collectively bargained planNo
2006-10-01Plan funding arrangement – InsuranceYes
2006-10-01Plan benefit arrangement – InsuranceYes
2005: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2005 form 5500 responses
2005-10-01Type of plan entitySingle employer plan
2005-10-01Submission has been amendedNo
2005-10-01This submission is the final filingNo
2005-10-01This return/report is a short plan year return/report (less than 12 months)No
2005-10-01Plan is a collectively bargained planNo
2005-10-01Plan funding arrangement – InsuranceYes
2005-10-01Plan benefit arrangement – InsuranceYes
2004: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2004 form 5500 responses
2004-10-01Type of plan entitySingle employer plan
2004-10-01Submission has been amendedNo
2004-10-01This submission is the final filingNo
2004-10-01This return/report is a short plan year return/report (less than 12 months)No
2004-10-01Plan is a collectively bargained planNo
2004-10-01Plan funding arrangement – InsuranceYes
2004-10-01Plan benefit arrangement – InsuranceYes
2003: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2003 form 5500 responses
2003-10-01Type of plan entitySingle employer plan
2003-10-01Submission has been amendedNo
2003-10-01This submission is the final filingNo
2003-10-01This return/report is a short plan year return/report (less than 12 months)No
2003-10-01Plan is a collectively bargained planNo
2003-10-01Plan funding arrangement – InsuranceYes
2003-10-01Plan benefit arrangement – InsuranceYes
2002: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2002 form 5500 responses
2002-10-01Type of plan entitySingle employer plan
2002-10-01Submission has been amendedNo
2002-10-01This submission is the final filingNo
2002-10-01This return/report is a short plan year return/report (less than 12 months)No
2002-10-01Plan is a collectively bargained planNo
2002-10-01Plan funding arrangement – InsuranceYes
2002-10-01Plan benefit arrangement – InsuranceYes
2001: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2001 form 5500 responses
2001-10-01Type of plan entitySingle employer plan
2001-10-01Submission has been amendedNo
2001-10-01This submission is the final filingNo
2001-10-01This return/report is a short plan year return/report (less than 12 months)No
2001-10-01Plan is a collectively bargained planNo
2001-10-01Plan funding arrangement – InsuranceYes
2001-10-01Plan benefit arrangement – InsuranceYes
2000: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 2000 form 5500 responses
2000-10-01Type of plan entitySingle employer plan
2000-10-01Submission has been amendedNo
2000-10-01This submission is the final filingNo
2000-10-01This return/report is a short plan year return/report (less than 12 months)No
2000-10-01Plan is a collectively bargained planNo
2000-10-01Plan funding arrangement – InsuranceYes
2000-10-01Plan benefit arrangement – InsuranceYes
1999: WEST SIDE COMMUNITY HEALTH SERVICES LIFE INSURANCE & DISABILITY PLAN 1999 form 5500 responses
1999-10-01Type of plan entitySingle employer plan
1999-10-01Submission has been amendedNo
1999-10-01This submission is the final filingNo
1999-10-01This return/report is a short plan year return/report (less than 12 months)No
1999-10-01Plan is a collectively bargained planNo
1999-10-01Plan funding arrangement – InsuranceYes
1999-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0BLDS
Policy instance 1
Insurance contract or identification numberGUG0BLDS
Number of Individuals Covered353
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $25,306
Total amount of fees paid to insurance companyUSD $3,606
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $253,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,840
Amount paid for insurance broker fees1942
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number162233
Policy instance 1
Insurance contract or identification number162233
Number of Individuals Covered338
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $23,634
Total amount of fees paid to insurance companyUSD $7,747
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,634
Amount paid for insurance broker fees5363
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number162233
Policy instance 1
Insurance contract or identification number162233
Number of Individuals Covered322
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $26,548
Total amount of fees paid to insurance companyUSD $6,668
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,647
Amount paid for insurance broker fees4616
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3

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