Insurance contract or identification number | 10234774 |
Number of Individuals Covered | 160 |
Insurance policy start date | 2022-07-01 |
Insurance policy end date | 2023-06-30 |
Total amount of commissions paid to insurance broker | USD $679 |
Total amount of fees paid to insurance company | USD $0 |
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 | 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 $4,526 |
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
Commission paid to Insurance Broker | USD $679 |
Insurance broker organization code? | 3 |