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40 SQUARE HEALTH PLAN TRUST 401k Plan overview

Plan Name40 SQUARE HEALTH PLAN TRUST
Plan identification number 501

40 SQUARE HEALTH PLAN TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

40 SQUARE COOPERATIVE SOLUTIONS has sponsored the creation of one or more 401k plans.

Company Name:40 SQUARE COOPERATIVE SOLUTIONS
Employer identification number (EIN):352605951
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 40 SQUARE HEALTH PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JOHN MCSORLEY2023-07-27 JOHN MCSORLEY2023-07-27
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01

Plan Statistics for 40 SQUARE HEALTH PLAN TRUST

401k plan membership statisitcs for 40 SQUARE HEALTH PLAN TRUST

Measure Date Value
2022: 40 SQUARE HEALTH PLAN TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01408
Total number of active participants reported on line 7a of the Form 55002022-01-01343
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01343
Total participants2022-01-01343
2021: 40 SQUARE HEALTH PLAN TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01441
Total number of active participants reported on line 7a of the Form 55002021-01-01408
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01408
Total participants2021-01-01408
2020: 40 SQUARE HEALTH PLAN TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-01477
Total number of active participants reported on line 7a of the Form 55002020-01-01441
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01441
Number of participants with account balances2020-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: 40 SQUARE HEALTH PLAN TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-01492
Total number of active participants reported on line 7a of the Form 55002019-01-01477
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01477
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01477
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: 40 SQUARE HEALTH PLAN TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-01475
Total number of active participants reported on line 7a of the Form 55002018-01-01492
Total of all active and inactive participants2018-01-01492
Total participants2018-01-01492

Financial Data on 40 SQUARE HEALTH PLAN TRUST

Measure Date Value
2022 : 40 SQUARE HEALTH PLAN TRUST 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$813,255
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,064,573
Total income from all sources (including contributions)2022-12-31$5,272,398
Total of all expenses incurred2022-12-31$5,335,292
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$3,291,744
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$5,272,398
Value of total assets at end of year2022-12-31$1,378,387
Value of total assets at beginning of year2022-12-31$1,692,599
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$2,043,548
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$374,973
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$396,405
Administrative expenses (other) incurred2022-12-31$554,044
Liabilities. Value of operating payables at end of year2022-12-31$38,525
Liabilities. Value of operating payables at beginning of year2022-12-31$69,370
Total non interest bearing cash at end of year2022-12-31$1,003,414
Total non interest bearing cash at beginning of year2022-12-31$1,296,194
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-62,894
Value of net assets at end of year (total assets less liabilities)2022-12-31$565,132
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$628,026
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$5,272,398
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,291,744
Contract administrator fees2022-12-31$1,489,504
Liabilities. Value of benefit claims payable at end of year2022-12-31$774,730
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$995,203
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2022-12-31222027092
2021 : 40 SQUARE HEALTH PLAN TRUST 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,064,573
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,104,579
Total income from all sources (including contributions)2021-12-31$5,987,956
Total of all expenses incurred2021-12-31$6,631,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$4,631,374
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$5,987,956
Value of total assets at end of year2021-12-31$1,692,599
Value of total assets at beginning of year2021-12-31$2,375,943
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,999,920
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$396,405
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$334,132
Administrative expenses (other) incurred2021-12-31$571,379
Liabilities. Value of operating payables at end of year2021-12-31$69,370
Liabilities. Value of operating payables at beginning of year2021-12-31$47,861
Total non interest bearing cash at end of year2021-12-31$1,296,194
Total non interest bearing cash at beginning of year2021-12-31$2,041,811
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-643,338
Value of net assets at end of year (total assets less liabilities)2021-12-31$628,026
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,271,364
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$5,987,956
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$4,631,374
Contract administrator fees2021-12-31$1,428,541
Liabilities. Value of benefit claims payable at end of year2021-12-31$995,203
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$1,056,718
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2021-12-31222027092
2020 : 40 SQUARE HEALTH PLAN TRUST 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,104,579
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$946,504
Total income from all sources (including contributions)2020-12-31$5,939,843
Total of all expenses incurred2020-12-31$6,154,622
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$4,326,828
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$5,939,843
Value of total assets at end of year2020-12-31$2,375,943
Value of total assets at beginning of year2020-12-31$2,432,647
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,827,794
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$334,132
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$1,210,973
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$24,055
Administrative expenses (other) incurred2020-12-31$499,487
Liabilities. Value of operating payables at end of year2020-12-31$47,861
Liabilities. Value of operating payables at beginning of year2020-12-31$19,476
Total non interest bearing cash at end of year2020-12-31$2,041,811
Total non interest bearing cash at beginning of year2020-12-31$1,221,674
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-214,779
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,271,364
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,486,143
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$5,939,843
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$4,326,828
Contract administrator fees2020-12-31$1,328,307
Liabilities. Value of benefit claims payable at end of year2020-12-31$1,056,718
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$902,973
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2020-12-31222027092
2019 : 40 SQUARE HEALTH PLAN TRUST 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$946,504
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$766,590
Total income from all sources (including contributions)2019-12-31$6,480,982
Total of all expenses incurred2019-12-31$5,143,259
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$3,420,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$6,480,982
Value of total assets at end of year2019-12-31$2,432,647
Value of total assets at beginning of year2019-12-31$915,010
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,723,130
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$1,687
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$1,210,973
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$262,318
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$24,055
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$25,742
Administrative expenses (other) incurred2019-12-31$515,046
Liabilities. Value of operating payables at end of year2019-12-31$19,476
Liabilities. Value of operating payables at beginning of year2019-12-31$12
Total non interest bearing cash at end of year2019-12-31$1,221,674
Total non interest bearing cash at beginning of year2019-12-31$651,005
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,337,723
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,486,143
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$148,420
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$6,480,982
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$3,420,129
Contract administrator fees2019-12-31$1,208,084
Liabilities. Value of benefit claims payable at end of year2019-12-31$902,973
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$740,836
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2019-12-31222027092
2018 : 40 SQUARE HEALTH PLAN TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$766,590
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$5,755,983
Total of all expenses incurred2018-12-31$5,607,563
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,849,325
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$5,755,983
Value of total assets at end of year2018-12-31$915,010
Value of total assets at beginning of year2018-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$1,758,238
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$5,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Participant contributions at end of year2018-12-31$1,687
Participant contributions at beginning of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$262,318
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$25,742
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Administrative expenses (other) incurred2018-12-31$643,197
Liabilities. Value of operating payables at end of year2018-12-31$12
Liabilities. Value of operating payables at beginning of year2018-12-31$0
Total non interest bearing cash at end of year2018-12-31$651,005
Total non interest bearing cash at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$148,420
Value of net assets at end of year (total assets less liabilities)2018-12-31$148,420
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$5,755,983
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,849,325
Contract administrator fees2018-12-31$1,115,041
Liabilities. Value of benefit claims payable at end of year2018-12-31$740,836
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31WITHUMSMITH+BROWN, PC
Accountancy firm EIN2018-12-31222027092

Form 5500 Responses for 40 SQUARE HEALTH PLAN TRUST

2022: 40 SQUARE HEALTH PLAN TRUST 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: 40 SQUARE HEALTH PLAN TRUST 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: 40 SQUARE HEALTH PLAN TRUST 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: 40 SQUARE HEALTH PLAN TRUST 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: 40 SQUARE HEALTH PLAN TRUST 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-420596
Policy instance 2
Insurance contract or identification number136-420596
Number of Individuals Covered276
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,120
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,120
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186961
Policy instance 1
Insurance contract or identification numberVG 186961
Number of Individuals Covered16
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $607
Total amount of fees paid to insurance companyUSD $304
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $607
Amount paid for insurance broker fees304
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-420596
Policy instance 2
Insurance contract or identification number136-420596
Number of Individuals Covered345
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $12,835
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,835
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186961
Policy instance 1
Insurance contract or identification numberVG 186961
Number of Individuals Covered23
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $752
Total amount of fees paid to insurance companyUSD $376
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $752
Amount paid for insurance broker fees376
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136420596-00002
Policy instance 3
Insurance contract or identification number136420596-00002
Number of Individuals Covered178
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,559
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,559
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136420596-00001
Policy instance 2
Insurance contract or identification number136420596-00001
Number of Individuals Covered136
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,944
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,944
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186961
Policy instance 1
Insurance contract or identification numberVG 186961
Number of Individuals Covered22
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136420596-00002
Policy instance 3
Insurance contract or identification number136420596-00002
Number of Individuals Covered184
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,939
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,939
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136420596-00001
Policy instance 2
Insurance contract or identification number136420596-00001
Number of Individuals Covered140
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,947
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,947
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186961
Policy instance 1
Insurance contract or identification numberVG 186961
Number of Individuals Covered22
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $610
Total amount of fees paid to insurance companyUSD $354
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $610
Amount paid for insurance broker fees354
Additional information about fees paid to insurance brokerAGENT/BROKER
Insurance broker organization code?3

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