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ROCKET FARM RESTAURANTS LLC WELFARE PLAN 401k Plan overview

Plan NameROCKET FARM RESTAURANTS LLC WELFARE PLAN
Plan identification number 501

ROCKET FARM RESTAURANTS LLC WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

ROCKET FARM RESTAURANTS LLC has sponsored the creation of one or more 401k plans.

Company Name:ROCKET FARM RESTAURANTS LLC
Employer identification number (EIN):320416546
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Additional information about ROCKET FARM RESTAURANTS LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 1851968

More information about ROCKET FARM RESTAURANTS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROCKET FARM RESTAURANTS LLC WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01SHIREEN HERRINGTON2023-09-21
5012020-12-01
5012019-12-01
5012018-12-01
5012017-12-01
5012016-12-01CRYSTAL KELLY
5012015-12-01CRYSTAL KELLY
5012014-12-01DARIENNE BALLESTER

Plan Statistics for ROCKET FARM RESTAURANTS LLC WELFARE PLAN

401k plan membership statisitcs for ROCKET FARM RESTAURANTS LLC WELFARE PLAN

Measure Date Value
2021: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01217
Total number of active participants reported on line 7a of the Form 55002021-12-01352
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01352
Number of employers contributing to the scheme2021-12-010
2020: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01258
Total number of active participants reported on line 7a of the Form 55002020-12-01213
Number of retired or separated participants receiving benefits2020-12-014
Total of all active and inactive participants2020-12-01217
2019: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01332
Total number of active participants reported on line 7a of the Form 55002019-12-01255
Number of retired or separated participants receiving benefits2019-12-013
Total of all active and inactive participants2019-12-01258
2018: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01265
Total number of active participants reported on line 7a of the Form 55002018-12-01328
Number of retired or separated participants receiving benefits2018-12-014
Total of all active and inactive participants2018-12-01332
2017: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01265
Total number of active participants reported on line 7a of the Form 55002017-12-01265
Total of all active and inactive participants2017-12-01265
2016: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01248
Total number of active participants reported on line 7a of the Form 55002016-12-01265
Total of all active and inactive participants2016-12-01265
2015: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01198
Total number of active participants reported on line 7a of the Form 55002015-12-01248
Total of all active and inactive participants2015-12-01248
2014: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01140
Total number of active participants reported on line 7a of the Form 55002014-12-01197
Number of retired or separated participants receiving benefits2014-12-011
Total of all active and inactive participants2014-12-01198

Form 5500 Responses for ROCKET FARM RESTAURANTS LLC WELFARE PLAN

2021: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedYes
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2017: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – General assets of the sponsorYes
2015: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – InsuranceYes
2014: ROCKET FARM RESTAURANTS LLC WELFARE PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01First time form 5500 has been submittedYes
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 3
Insurance contract or identification number5913417
Number of Individuals Covered226
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $43,907
Total amount of fees paid to insurance companyUSD $4,296
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,HOSPITAL,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $177,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,713
Amount paid for insurance broker fees27
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES, NON-MONETARY COMPENSATION
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number218717
Policy instance 2
Insurance contract or identification number218717
Number of Individuals Covered352
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 2
Insurance contract or identification number5913417
Number of Individuals Covered226
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $44,202
Total amount of fees paid to insurance companyUSD $4,333
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,HOSPITAL,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $184,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,747
Amount paid for insurance broker fees-25
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES, NON-MONETARY COMPENSATION, NON-MONETARY COMPENSATION, PRODUCER SERVICE FEES
Insurance broker organization code?3
FLEXCARE, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGRSRFR
Policy instance 1
Insurance contract or identification numberGRSRFR
Number of Individuals Covered352
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $2,044
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM, TELEHEALTH
Welfare Benefit Premiums Paid to CarrierUSD $26,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,044
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218717
Policy instance 1
Insurance contract or identification number218717
Number of Individuals Covered46
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $1,444
Total amount of fees paid to insurance companyUSD $848
Other welfare benefits providedWSTD
Welfare Benefit Premiums Paid to CarrierUSD $22,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,011
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 2
Insurance contract or identification number5913417
Number of Individuals Covered213
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $14,898
Total amount of fees paid to insurance companyUSD $4,985
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $133,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,012
Amount paid for insurance broker fees4985
Additional information about fees paid to insurance brokerSERVICE, MARKETING, NON-MONETARY AND SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0218713
Policy instance 3
Insurance contract or identification number0218713
Number of Individuals Covered50
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $2,754
Total amount of fees paid to insurance companyUSD $438
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $11,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,928
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSERVICE, MARKETING, NON-MONETARY AND SUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218715
Policy instance 4
Insurance contract or identification number218715
Number of Individuals Covered61
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $7,927
Total amount of fees paid to insurance companyUSD $809
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $27,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,549
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSERVICE, MARKETING NON-MONETARY AND SUPPLEMENT COMPENSATION
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16993
Policy instance 5
Insurance contract or identification number16993
Number of Individuals Covered151
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $158,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218714
Policy instance 6
Insurance contract or identification number218714
Number of Individuals Covered130
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $5,824
Total amount of fees paid to insurance companyUSD $775
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $25,279
Commission paid to Insurance BrokerUSD $4,078
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSERVICE, MARKETING, NON-MONETARY AND SUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218717
Policy instance 6
Insurance contract or identification number218717
Number of Individuals Covered66
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $28,518
Total amount of fees paid to insurance companyUSD $228
Other welfare benefits providedWSTD
Welfare Benefit Premiums Paid to CarrierUSD $61,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,963
Amount paid for insurance broker fees184
Additional information about fees paid to insurance brokerSUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16993
Policy instance 5
Insurance contract or identification number16993
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Welfare Benefit Premiums Paid to CarrierUSD $137,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218714
Policy instance 4
Insurance contract or identification number218714
Number of Individuals Covered245
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $21,762
Total amount of fees paid to insurance companyUSD $2,077
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $38,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,235
Amount paid for insurance broker fees1264
Additional information about fees paid to insurance brokerADDITIONAL, SUPPLEMENT & NON-MONETARY
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0218713
Policy instance 3
Insurance contract or identification number0218713
Number of Individuals Covered69
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $14,416
Total amount of fees paid to insurance companyUSD $155
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $16,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,124
Amount paid for insurance broker fees111
Additional information about fees paid to insurance brokerSUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218715
Policy instance 2
Insurance contract or identification number218715
Number of Individuals Covered94
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $16,112
Total amount of fees paid to insurance companyUSD $162
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $34,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,278
Amount paid for insurance broker fees118
Additional information about fees paid to insurance brokerSUPPLEMENTAL & NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 1
Insurance contract or identification number5913417
Number of Individuals Covered255
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $11,592
Total amount of fees paid to insurance companyUSD $12,243
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $180,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,592
Amount paid for insurance broker fees12243
Additional information about fees paid to insurance brokerSERVICE FEES, SUPPLEMENTAL & NON- MONETARY COMPENSATION
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4714689
Policy instance 1
Insurance contract or identification numberE4714689
Number of Individuals Covered219
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $3,229
Total amount of fees paid to insurance companyUSD $375
Other welfare benefits providedACCIDENT,CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $10,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $110
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95094 )
Policy contract number0737855HNO
Policy instance 2
Insurance contract or identification number0737855HNO
Number of Individuals Covered250
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,162,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218715
Policy instance 3
Insurance contract or identification number218715
Number of Individuals Covered76
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $16,112
Total amount of fees paid to insurance companyUSD $162
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $26,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,278
Amount paid for insurance broker fees118
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETRARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 4
Insurance contract or identification number5913417
Number of Individuals Covered307
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $12,104
Total amount of fees paid to insurance companyUSD $246
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $168,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,104
Amount paid for insurance broker fees246
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218713
Policy instance 5
Insurance contract or identification number218713
Number of Individuals Covered108
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $14,416
Total amount of fees paid to insurance companyUSD $155
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $23,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,124
Amount paid for insurance broker fees111
Additional information about fees paid to insurance brokerSUPPLEMNETAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218714
Policy instance 6
Insurance contract or identification number218714
Number of Individuals Covered234
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $21,762
Total amount of fees paid to insurance companyUSD $2,077
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $36,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,235
Amount paid for insurance broker fees1264
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0218713
Policy instance 7
Insurance contract or identification number0218713
Number of Individuals Covered103
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $14,416
Total amount of fees paid to insurance companyUSD $155
Other welfare benefits providedCRITICAL ILLNESS
Commission paid to Insurance BrokerUSD $10,127
Amount paid for insurance broker fees111
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0737855
Policy instance 8
Insurance contract or identification number0737855
Number of Individuals Covered19
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number218717
Policy instance 9
Insurance contract or identification number218717
Number of Individuals Covered110
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $28,518
Total amount of fees paid to insurance companyUSD $228
Other welfare benefits providedWSTD
Welfare Benefit Premiums Paid to CarrierUSD $47,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,963
Amount paid for insurance broker fees184
Additional information about fees paid to insurance brokerSUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5913417
Policy instance 4
Insurance contract or identification number5913417
Number of Individuals Covered263
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $8,349
Total amount of fees paid to insurance companyUSD $16
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $152,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0737855
Policy instance 3
Insurance contract or identification number0737855
Number of Individuals Covered3
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95094 )
Policy contract number0737855HNO
Policy instance 2
Insurance contract or identification number0737855HNO
Number of Individuals Covered262
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,100
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,060,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4714689
Policy instance 1
Insurance contract or identification numberE4714689
Number of Individuals Covered224
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $52,748
Total amount of fees paid to insurance companyUSD $15,113

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