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CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameCUYAHOGA VENDING EMPLOYEE BENEFIT PLAN
Plan identification number 501

CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

CUYAHOGA VENDING & DINING has sponsored the creation of one or more 401k plans.

Company Name:CUYAHOGA VENDING & DINING
Employer identification number (EIN):341568942
NAIC Classification:454210
NAIC Description:Vending Machine Operators

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-09-01
5012015-09-01
5012014-09-01
5012014-09-01
5012013-09-01
5012012-09-01CAROLINE POESSE
5012011-09-01CAROLINE POESSE
5012010-09-01CAROLINE POESSE
5012010-09-01CAROLINE POESSE
5012009-09-01CAROLINE POESSE
5012008-09-01CAROLINE POESSE
5012007-09-01CAROLINE POESSE
5012006-09-01CAROLINE POESSE

Plan Statistics for CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN

Measure Date Value
2016: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01285
Total of all active and inactive participants2016-09-010
Total participants2016-09-010
2015: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01163
Total number of active participants reported on line 7a of the Form 55002015-09-01265
Total of all active and inactive participants2015-09-01265
2014: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01155
Total number of active participants reported on line 7a of the Form 55002014-09-01163
Total of all active and inactive participants2014-09-01163
2013: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01156
Total number of active participants reported on line 7a of the Form 55002013-09-01155
Total of all active and inactive participants2013-09-01155
2012: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01125
Total number of active participants reported on line 7a of the Form 55002012-09-01156
Total of all active and inactive participants2012-09-01156
2011: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01132
Total number of active participants reported on line 7a of the Form 55002011-09-01125
Total of all active and inactive participants2011-09-01125
2010: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-01128
Total number of active participants reported on line 7a of the Form 55002010-09-01132
Total of all active and inactive participants2010-09-01132
2009: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01126
Total number of active participants reported on line 7a of the Form 55002009-09-01128
Total of all active and inactive participants2009-09-01128
2008: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-09-01121
Total number of active participants reported on line 7a of the Form 55002008-09-01126
Total of all active and inactive participants2008-09-01126
2007: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-09-01115
Total number of active participants reported on line 7a of the Form 55002007-09-01121
Total of all active and inactive participants2007-09-01121
2006: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-09-01105
Total number of active participants reported on line 7a of the Form 55002006-09-01115
Total of all active and inactive participants2006-09-01115

Form 5500 Responses for CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN

2016: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01First time form 5500 has been submittedYes
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – General assets of the sponsorYes
2015: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – General assets of the sponsorYes
2014: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedYes
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan funding arrangement – General assets of the sponsorYes
2014-09-01Plan benefit arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – General assets of the sponsorYes
2013: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan funding arrangement – General assets of the sponsorYes
2013-09-01Plan benefit arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – General assets of the sponsorYes
2012: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan funding arrangement – General assets of the sponsorYes
2012-09-01Plan benefit arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – General assets of the sponsorYes
2011: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan funding arrangement – General assets of the sponsorYes
2011-09-01Plan benefit arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – General assets of the sponsorYes
2010: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Submission has been amendedYes
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan funding arrangement – General assets of the sponsorYes
2010-09-01Plan benefit arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – General assets of the sponsorYes
2009: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01This submission is the final filingNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan funding arrangement – General assets of the sponsorYes
2009-09-01Plan benefit arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – General assets of the sponsorYes
2008: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2008 form 5500 responses
2008-09-01Type of plan entitySingle employer plan
2008-09-01Plan funding arrangement – InsuranceYes
2008-09-01Plan funding arrangement – General assets of the sponsorYes
2008-09-01Plan benefit arrangement – InsuranceYes
2008-09-01Plan benefit arrangement – General assets of the sponsorYes
2007: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2007 form 5500 responses
2007-09-01Type of plan entitySingle employer plan
2007-09-01Plan funding arrangement – InsuranceYes
2007-09-01Plan funding arrangement – General assets of the sponsorYes
2007-09-01Plan benefit arrangement – InsuranceYes
2007-09-01Plan benefit arrangement – General assets of the sponsorYes
2006: CUYAHOGA VENDING EMPLOYEE BENEFIT PLAN 2006 form 5500 responses
2006-09-01Type of plan entitySingle employer plan
2006-09-01First time form 5500 has been submittedYes
2006-09-01Plan funding arrangement – InsuranceYes
2006-09-01Plan funding arrangement – General assets of the sponsorYes
2006-09-01Plan benefit arrangement – InsuranceYes
2006-09-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00516407
Policy instance 2
Insurance contract or identification number00516407
Number of Individuals Covered265
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $4,671
Total amount of fees paid to insurance companyUSD $321
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,671
Amount paid for insurance broker fees321
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC.
AMERICAN ALTERNATIVE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 19720 )
Policy contract number
Policy instance 1
Number of Individuals Covered189
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $111,963
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $320,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees111963
Additional information about fees paid to insurance brokerADMINISTRATION, MANAGEMENT AND UTILIZATION REVIEW
Insurance broker organization code?3
Insurance broker nameMERITAIN HEALTH
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number232244
Policy instance 2
Insurance contract or identification number232244
Number of Individuals Covered173
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $18,507
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $290,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,966
Insurance broker organization code?3
Insurance broker nameCPI-HR
CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )
Policy contract number552199
Policy instance 1
Insurance contract or identification number552199
Number of Individuals Covered155
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,838
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 number232244
Policy instance 3
Insurance contract or identification number232244
Number of Individuals Covered155
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $33,444
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $236,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,444
Insurance broker nameCPI CORPORATE PLANS INC.
CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )
Policy contract number552199
Policy instance 1
Insurance contract or identification number552199
Number of Individuals Covered155
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI-70521
Policy instance 2
Insurance contract or identification numberCLI-70521
Number of Individuals Covered0
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $79
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 numberNWL0157OH-02
Policy instance 1
Insurance contract or identification numberNWL0157OH-02
Number of Individuals Covered0
Insurance policy start date2012-09-01
Insurance policy end date2012-09-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 )
Policy contract number552199
Policy instance 3
Insurance contract or identification number552199
Number of Individuals Covered156
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameCPI - CORPORATE PLANS INC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI-70521
Policy instance 2
Insurance contract or identification numberCLI-70521
Number of Individuals Covered140
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $47,634
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $199,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,634
Insurance broker organization code?3
Insurance broker nameCPI - CORPORATE PLANS INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNWL0157OH-02
Policy instance 2
Insurance contract or identification numberNWL0157OH-02
Number of Individuals Covered123
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $194,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 1
Insurance contract or identification number129189
Number of Individuals Covered154
Insurance policy start date2011-11-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $1,561
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 2
Insurance contract or identification number129189
Number of Individuals Covered156
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $1,626
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
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 numberNWL0157OH-01
Policy instance 1
Insurance contract or identification numberNWL0157OH-01
Number of Individuals Covered128
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $173,217
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 numberNWL0157OH-01
Policy instance 2
Insurance contract or identification numberNWL0157OH-01
Number of Individuals Covered128
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $173,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 1
Insurance contract or identification number129189
Number of Individuals Covered156
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $1,626
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 2
Insurance contract or identification number129189
Number of Individuals Covered154
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $1,377
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberIIS 00190-09
Policy instance 1
Insurance contract or identification numberIIS 00190-09
Number of Individuals Covered129
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $154,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 2
Insurance contract or identification number129189
Number of Individuals Covered156
Insurance policy start date2008-11-01
Insurance policy end date2009-10-31
Total amount of commissions paid to insurance brokerUSD $1,469
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,469
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP INC.
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberIIS 00190-07
Policy instance 1
Insurance contract or identification numberIIS 00190-07
Number of Individuals Covered116
Insurance policy start date2008-09-01
Insurance policy end date2009-08-31
Total amount of commissions paid to insurance brokerUSD $9,643
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $137,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,643
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameAMERICAN BENEFITS MANAGEMENT
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberIIS 00190-07
Policy instance 1
Insurance contract or identification numberIIS 00190-07
Number of Individuals Covered132
Insurance policy start date2007-09-01
Insurance policy end date2008-08-31
Total amount of commissions paid to insurance brokerUSD $9,832
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $140,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,832
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameAMERICAN BENEFITS MANAGEMENT
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 2
Insurance contract or identification number129189
Number of Individuals Covered154
Insurance policy start date2007-11-01
Insurance policy end date2008-10-31
Total amount of commissions paid to insurance brokerUSD $1,199
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,199
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number129189
Policy instance 2
Insurance contract or identification number129189
Number of Individuals Covered156
Insurance policy start date2006-11-01
Insurance policy end date2007-10-31
Total amount of commissions paid to insurance brokerUSD $1,213
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,213
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP INC.
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberIIS 00190-06
Policy instance 1
Insurance contract or identification numberIIS 00190-06
Number of Individuals Covered126
Insurance policy start date2006-09-01
Insurance policy end date2007-08-31
Total amount of commissions paid to insurance brokerUSD $7,489
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $106,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,489
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameAMERICAN BENEFITS MANAGEMENT

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