NEW SEASONS MARKET LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NEW SEASONS MARKET WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: NEW SEASONS MARKET WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 3,429 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 3,070 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 3,072 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: NEW SEASONS MARKET WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 3,178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 3,411 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 18 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 3,429 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: NEW SEASONS MARKET WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 3,391 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 3,133 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 45 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 3,178 |
| 2019: NEW SEASONS MARKET WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 3,481 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 3,024 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 30 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 30 |
| Total of all active and inactive participants | 2019-01-01 | 3,084 |
| 2018: NEW SEASONS MARKET WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 3,949 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 2,977 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 27 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 3,004 |
| 2017: NEW SEASONS MARKET WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 3,733 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 3,694 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 31 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 31 |
| Total of all active and inactive participants | 2017-04-01 | 3,756 |
| 2016: NEW SEASONS MARKET WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 3,643 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 2,957 |
| Number of retired or separated participants receiving benefits | 2016-04-01 | 32 |
| Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 41 |
| Total of all active and inactive participants | 2016-04-01 | 3,030 |
| 2015: NEW SEASONS MARKET WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 2,403 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 2,525 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 23 |
| Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 90 |
| Total of all active and inactive participants | 2015-04-01 | 2,638 |
| 2014: NEW SEASONS MARKET WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 2,499 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 2,892 |
| Number of retired or separated participants receiving benefits | 2014-04-01 | 14 |
| Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 72 |
| Total of all active and inactive participants | 2014-04-01 | 2,978 |
| 2013: NEW SEASONS MARKET WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 2,221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 2,649 |
| Number of retired or separated participants receiving benefits | 2013-04-01 | 17 |
| Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 38 |
| Total of all active and inactive participants | 2013-04-01 | 2,704 |
| 2012: NEW SEASONS MARKET WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 2,253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 2,221 |
| Number of retired or separated participants receiving benefits | 2012-04-01 | 9 |
| Total of all active and inactive participants | 2012-04-01 | 2,230 |
| 2022: NEW SEASONS MARKET WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: NEW SEASONS MARKET WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: NEW SEASONS MARKET WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: NEW SEASONS MARKET WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: NEW SEASONS MARKET WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: NEW SEASONS MARKET WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: NEW SEASONS MARKET WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: NEW SEASONS MARKET WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: NEW SEASONS MARKET WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: NEW SEASONS MARKET WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: NEW SEASONS MARKET WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL161267 |
| Policy instance | 3 |
| Insurance contract or identification number | GL161267 | | Number of Individuals Covered | 3070 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $583,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 01-351034 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-351034 | | Number of Individuals Covered | 3555 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $927 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $203,112 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 927 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | 00 |
| Policy instance | 1 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 2856 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $120,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | 00 |
| Policy instance | 2 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 3411 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $126,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 1 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 1951 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $226,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL161267 |
| Policy instance | 3 |
| Insurance contract or identification number | GL161267 | | Number of Individuals Covered | 3142 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $34,129 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $726,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 26003 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 1 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 2027 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | 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 $237,347 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 161267 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 161267 | | Number of Individuals Covered | 3402 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, DEPENDENT LIFE & SUPPLEMENTAL LIFE | | 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 $221,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 167188 |
| Policy instance | 3 |
| Insurance contract or identification number | G 167188 | | Number of Individuals Covered | 3555 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 $317,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL 303309 |
| Policy instance | 4 |
| Insurance contract or identification number | VPL 303309 | | Number of Individuals Covered | 817 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY LONG TERM DISABILITY | | 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 $82,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 208817 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR 208817 | | Number of Individuals Covered | 1108 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | | 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 $27,943 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | NEWSEASONS |
| Policy instance | 1 |
| Insurance contract or identification number | NEWSEASONS | | Number of Individuals Covered | 3788 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $129,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 2 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 2124 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00546757 |
| Policy instance | 3 |
| Insurance contract or identification number | 00546757 | | Number of Individuals Covered | 3405 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $15,763 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $756,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 15763 | | Additional information about fees paid to insurance broker | ADMINISTRATION | | Insurance broker organization code? | 3 |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | NEWSEASONS |
| Policy instance | 2 |
| Insurance contract or identification number | NEWSEASONS | | Number of Individuals Covered | 4065 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $102,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 3 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 2234 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G162684 |
| Policy instance | 4 |
| Insurance contract or identification number | G162684 | | Number of Individuals Covered | 3694 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $206,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR205738 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR205738 | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 183637 |
| Policy instance | 6 |
| Insurance contract or identification number | VG 183637 | | Number of Individuals Covered | 894 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL150919 |
| Policy instance | 7 |
| Insurance contract or identification number | GL150919 | | Number of Individuals Covered | 3518 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $44,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 234769 |
| Policy instance | 8 |
| Insurance contract or identification number | 234769 | | Number of Individuals Covered | 2893 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $95,827 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,436,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,885 | | Insurance broker organization code? | 3 | | Insurance broker name | UNITED BENEFIT ADVISORS NORTHWEST L |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301228 |
| Policy instance | 1 |
| Insurance contract or identification number | VPL301228 | | Number of Individuals Covered | 774 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ZOOM HEALTH PLAN, INC (National Association of Insurance Commissioners NAIC id number: 15578 ) |
| Policy contract number | 5 |
| Policy instance | 9 |
| Insurance contract or identification number | 5 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $451,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301228 |
| Policy instance | 1 |
| Insurance contract or identification number | VPL301228 | | Number of Individuals Covered | 634 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 234769 |
| Policy instance | 8 |
| Insurance contract or identification number | 234769 | | Number of Individuals Covered | 6896 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $102,656 | | Welfare Benefit Premiums Paid to Carrier | USD $1,270,193 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,437 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | UNITED BENEFIT ADVISORS NORTHWEST L |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL150919 |
| Policy instance | 7 |
| Insurance contract or identification number | GL150919 | | Number of Individuals Covered | 2732 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $59,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 183637 |
| Policy instance | 6 |
| Insurance contract or identification number | VG 183637 | | Number of Individuals Covered | 817 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR205738 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR205738 | | Number of Individuals Covered | 932 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $40,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G162684 |
| Policy instance | 4 |
| Insurance contract or identification number | G162684 | | Number of Individuals Covered | 3177 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $327,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 3 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 1859 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | NEWSEASONS |
| Policy instance | 2 |
| Insurance contract or identification number | NEWSEASONS | | Number of Individuals Covered | 3138 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $99,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301228 |
| Policy instance | 1 |
| Insurance contract or identification number | VPL301228 | | Number of Individuals Covered | 616 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | NEWSEASONS |
| Policy instance | 2 |
| Insurance contract or identification number | NEWSEASONS | | Number of Individuals Covered | 2907 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $87,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G162684 |
| Policy instance | 4 |
| Insurance contract or identification number | G162684 | | Number of Individuals Covered | 2851 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $303,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR205738 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR205738 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $39,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 183637 |
| Policy instance | 6 |
| Insurance contract or identification number | VG 183637 | | Number of Individuals Covered | 801 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $154,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 3 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 1737 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 234769 |
| Policy instance | 8 |
| Insurance contract or identification number | 234769 | | Number of Individuals Covered | 6896 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $82,681 | | Total amount of fees paid to insurance company | USD $1,298 | | Welfare Benefit Premiums Paid to Carrier | USD $1,102,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,121 | | Amount paid for insurance broker fees | 1298 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | UNITED BENEFIT ADVISORS NORTHWEST L |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL150919 |
| Policy instance | 7 |
| Insurance contract or identification number | GL150919 | | Number of Individuals Covered | 2511 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $53,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPL301228 |
| Policy instance | 1 |
| Insurance contract or identification number | VPL301228 | | Number of Individuals Covered | 605 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-14 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | NEWSEASONS |
| Policy instance | 2 |
| Insurance contract or identification number | NEWSEASONS | | Number of Individuals Covered | 2596 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $72,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G162684 |
| Policy instance | 4 |
| Insurance contract or identification number | G162684 | | Number of Individuals Covered | 2130 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-14 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $248,477 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR205738 |
| Policy instance | 5 |
| Insurance contract or identification number | VAR205738 | | Number of Individuals Covered | 860 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-14 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $35,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 183637 |
| Policy instance | 6 |
| Insurance contract or identification number | VG 183637 | | Number of Individuals Covered | 778 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-14 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 3 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 1596 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $162,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 038925 |
| Policy instance | 1 |
| Insurance contract or identification number | 038925 | | Number of Individuals Covered | 2252 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $3,474 | | Total amount of fees paid to insurance company | USD $393 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,474 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | ADDTIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PARKER SMITH AND FEEK INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12338500 |
| Policy instance | 4 |
| Insurance contract or identification number | 12338500 | | Number of Individuals Covered | 1423 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0219006 |
| Policy instance | 3 |
| Insurance contract or identification number | R0219006 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $1,804 | | Total amount of fees paid to insurance company | USD $300 | | Other welfare benefits provided | GROUP VOL. CRITICAL ILLNESS INSURAN | | Welfare Benefit Premiums Paid to Carrier | USD $18,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43 | | Amount paid for insurance broker fees | 4 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT COMMUNICATIONS INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 038926 |
| Policy instance | 2 |
| Insurance contract or identification number | 038926 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $7,870 | | Total amount of fees paid to insurance company | USD $393 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $48,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,870 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | PARKER SMITH AND FEEK INC |
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