BOGGUS MOTOR COMPANY II LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN
401k plan membership statisitcs for BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN
| Measure | Date | Value |
|---|
| 2021: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 258 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 138 |
| Total of all active and inactive participants | 2021-08-01 | 138 |
| 2020: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 258 |
| Total of all active and inactive participants | 2020-08-01 | 258 |
| 2019: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 127 |
| Total of all active and inactive participants | 2019-08-01 | 127 |
| 2018: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 183 |
| Total of all active and inactive participants | 2018-08-01 | 183 |
| 2017: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 228 |
| Total of all active and inactive participants | 2017-08-01 | 228 |
| 2016: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 246 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 254 |
| Total of all active and inactive participants | 2016-08-01 | 254 |
| 2015: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 219 |
| Total of all active and inactive participants | 2015-08-01 | 219 |
| 2014: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 200 |
| Total of all active and inactive participants | 2014-08-01 | 200 |
| 2013: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 204 |
| Total of all active and inactive participants | 2013-08-01 | 204 |
| Total participants, beginning-of-year | 2013-07-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 208 |
| Total of all active and inactive participants | 2013-07-01 | 208 |
| 2012: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 209 |
| Total of all active and inactive participants | 2012-07-01 | 209 |
| 2011: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 199 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 201 |
| Total of all active and inactive participants | 2011-07-01 | 201 |
| 2021: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Mulitple employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Mulitple employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Submission has been amended | No |
| 2017-08-01 | This submission is the final filing | No |
| 2017-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-08-01 | Plan is a collectively bargained plan | No |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Submission has been amended | No |
| 2016-08-01 | This submission is the final filing | No |
| 2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-08-01 | Plan is a collectively bargained plan | No |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Submission has been amended | No |
| 2015-08-01 | This submission is the final filing | No |
| 2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-08-01 | Plan is a collectively bargained plan | No |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Submission has been amended | No |
| 2014-08-01 | This submission is the final filing | No |
| 2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-08-01 | Plan is a collectively bargained plan | No |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Submission has been amended | No |
| 2013-08-01 | This submission is the final filing | No |
| 2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-08-01 | Plan is a collectively bargained plan | No |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BOGGUS MOTOR COMPANY II LLC LIFE & HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 882062 |
| Policy instance | 3 |
| Insurance contract or identification number | 882062 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $1,741 | | Total amount of fees paid to insurance company | USD $627 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $8,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,393 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 279 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 321824 |
| Policy instance | 2 |
| Insurance contract or identification number | 321824 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $39,515 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $837,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,515 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 65039 |
| Policy instance | 1 |
| Insurance contract or identification number | 65039 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $15,091 | | Total amount of fees paid to insurance company | USD $4,188 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $134,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,091 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4188 | | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 882064 |
| Policy instance | 4 |
| Insurance contract or identification number | 882064 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $12,847 | | Total amount of fees paid to insurance company | USD $3,240 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,785 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 178 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 65039 |
| Policy instance | 1 |
| Insurance contract or identification number | 65039 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $4,791 | | Total amount of fees paid to insurance company | USD $3,875 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $122,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,791 | | Amount paid for insurance broker fees | 3875 | | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | NIS154601 |
| Policy instance | 2 |
| Insurance contract or identification number | NIS154601 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $26,711 | | Welfare Benefit Premiums Paid to Carrier | USD $178,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,711 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 882062 |
| Policy instance | 3 |
| Insurance contract or identification number | 882062 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,236 | | Total amount of fees paid to insurance company | USD $805 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $7,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,789 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 358 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 882064 |
| Policy instance | 4 |
| Insurance contract or identification number | 882064 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $11,440 | | Total amount of fees paid to insurance company | USD $4,934 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,699 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2193 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT4109 |
| Policy instance | 5 |
| Insurance contract or identification number | HCCLOT4109 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $1,300 | | Total amount of fees paid to insurance company | USD $434 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $13,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,300 | | Amount paid for insurance broker fees | 434 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58342 |
| Policy instance | 6 |
| Insurance contract or identification number | 58342 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $4,388 | | Total amount of fees paid to insurance company | USD $2,648 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER, ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $78,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,388 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2648 | | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT4109 |
| Policy instance | 5 |
| Insurance contract or identification number | HCCLOT4109 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $1,567 | | Total amount of fees paid to insurance company | USD $563 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $15,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,567 | | Amount paid for insurance broker fees | 563 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US1181805 |
| Policy instance | 4 |
| Insurance contract or identification number | US1181805 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $27,997 | | Welfare Benefit Premiums Paid to Carrier | USD $186,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,997 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 931311 |
| Policy instance | 3 |
| Insurance contract or identification number | 931311 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $10,148 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,148 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900563 |
| Policy instance | 2 |
| Insurance contract or identification number | 900563 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $6,675 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $31,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,675 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 65039 |
| Policy instance | 1 |
| Insurance contract or identification number | 65039 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of fees paid to insurance company | USD $3,882 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER; ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $122,415 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3882 | | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 65039 |
| Policy instance | 1 |
| Insurance contract or identification number | 65039 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $4,587 | | Total amount of fees paid to insurance company | USD $4,112 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER; ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $128,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4112 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $4,587 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 900563 |
| Policy instance | 2 |
| Insurance contract or identification number | 900563 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $5,142 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $27,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,142 | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5485939 |
| Policy instance | 3 |
| Insurance contract or identification number | 5485939 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $9,390 | | Total amount of fees paid to insurance company | USD $527 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,390 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 527 | | Additional information about fees paid to insurance broker | BONUS COMMISSIONS |
|
| HIIG (National Association of Insurance Commissioners NAIC id number: 18694 ) |
| Policy contract number | GMICMSL10281 |
| Policy instance | 4 |
| Insurance contract or identification number | GMICMSL10281 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $41,200 | | Welfare Benefit Premiums Paid to Carrier | USD $274,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,200 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-6774 |
| Policy instance | 5 |
| Insurance contract or identification number | 947-6774 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $2,555 | | Total amount of fees paid to insurance company | USD $920 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $25,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,555 | | Amount paid for insurance broker fees | 920 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-5393 |
| Policy instance | 5 |
| Insurance contract or identification number | 947-5393 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $2,983 | | Total amount of fees paid to insurance company | USD $1,073 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $29,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | NIS1093 |
| Policy instance | 4 |
| Insurance contract or identification number | NIS1093 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $42,076 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $280,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5485939 |
| Policy instance | 3 |
| Insurance contract or identification number | 5485939 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $10,638 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,190 | | 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 | 900563 |
| Policy instance | 2 |
| Insurance contract or identification number | 900563 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $5,904 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $29,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 65039/58342 |
| Policy instance | 1 |
| Insurance contract or identification number | 65039/58342 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $5,810 | | Total amount of fees paid to insurance company | USD $5,609 | | Health Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER; ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $163,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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