401k Plan data: CHICAGO DRYER CO. plan

CHICAGO DRYER CO. 401k Plan overview

Plan Name	CHICAGO DRYER CO.
Plan identification number	501

CHICAGO DRYER CO. Benefits

401k Plan Type	Welfare 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)

401k Sponsoring company profile

CHICAGO DRYER COMPANY has sponsored the creation of one or more 401k plans.

Company Name: CHICAGO DRYER COMPANY

Employer identification number (EIN): 360899050

NAIC Classification: 333310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHICAGO DRYER CO.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 BRUCE W JOHNSON BRUCE W JOHNSON 2019-02-08
501 2017-01-01 BRUCE W JOHNSON BRUCE W JOHNSON 2018-04-19
501 2017-01-01 BRUCE W JOHNSON BRUCE W JOHNSON 2019-02-06
501 2016-11-01 BRUCE W JOHNSON BRUCE W JOHNSON 2017-06-26
501 2015-11-01 BRUCE W JOHNSON BRUCE W JOHNSON 2016-12-14
501 2015-01-01 BRUCE W JOHNSON BRUCE W JOHNSON 2016-02-05
501 2014-01-01 BRUCE JOHNSON BRUCE JOHNSON 2015-11-04
501 2013-01-01 BRUCE JOHNSON BRUCE JOHNSON 2015-11-04
501 2012-01-01 BRUCE JOHNSON BRUCE JOHNSON 2015-11-04

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2019-02-08
501	2017-01-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2018-04-19
501	2017-01-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2019-02-06
501	2016-11-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2017-06-26
501	2015-11-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2016-12-14
501	2015-01-01	BRUCE W JOHNSON	BRUCE W JOHNSON	2016-02-05
501	2014-01-01	BRUCE JOHNSON	BRUCE JOHNSON	2015-11-04
501	2013-01-01	BRUCE JOHNSON	BRUCE JOHNSON	2015-11-04
501	2012-01-01	BRUCE JOHNSON	BRUCE JOHNSON	2015-11-04

Plan Statistics for CHICAGO DRYER CO.

401k plan membership statisitcs for CHICAGO DRYER CO.

Measure Date Value
2022: CHICAGO DRYER CO. 2022 401k membership
Total participants, beginning-of-year 2022-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 217
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 217
2021: CHICAGO DRYER CO. 2021 401k membership
Total participants, beginning-of-year 2021-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 233
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 233
2020: CHICAGO DRYER CO. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 151
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 151
2019: CHICAGO DRYER CO. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 144
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 144
2018: CHICAGO DRYER CO. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 133
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 133
2017: CHICAGO DRYER CO. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 131
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 131
2016: CHICAGO DRYER CO. 2016 401k membership
Total participants, beginning-of-year 2016-11-01 130
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 129
Number of retired or separated participants receiving benefits 2016-11-01 0
Number of other retired or separated participants entitled to future benefits 2016-11-01 0
Total of all active and inactive participants 2016-11-01 129
2015: CHICAGO DRYER CO. 2015 401k membership
Total participants, beginning-of-year 2015-11-01 121
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 130
Number of retired or separated participants receiving benefits 2015-11-01 0
Number of other retired or separated participants entitled to future benefits 2015-11-01 0
Total of all active and inactive participants 2015-11-01 130
Total participants 2015-11-01 130
Total participants, beginning-of-year 2015-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 121
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 121
2014: CHICAGO DRYER CO. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 131
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 131
2013: CHICAGO DRYER CO. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 137
Total of all active and inactive participants 2013-01-01 137
2012: CHICAGO DRYER CO. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 132
Total of all active and inactive participants 2012-01-01 132

Measure	Date	Value
2022: CHICAGO DRYER CO. 2022 401k membership
Total participants, beginning-of-year	2022-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	217
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	217
2021: CHICAGO DRYER CO. 2021 401k membership
Total participants, beginning-of-year	2021-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	233
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	233
2020: CHICAGO DRYER CO. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	151
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	151
2019: CHICAGO DRYER CO. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	144
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	144
2018: CHICAGO DRYER CO. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	133
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	133
2017: CHICAGO DRYER CO. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	131
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	131
2016: CHICAGO DRYER CO. 2016 401k membership
Total participants, beginning-of-year	2016-11-01	130
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	129
Number of retired or separated participants receiving benefits	2016-11-01	0
Number of other retired or separated participants entitled to future benefits	2016-11-01	0
Total of all active and inactive participants	2016-11-01	129
2015: CHICAGO DRYER CO. 2015 401k membership
Total participants, beginning-of-year	2015-11-01	121
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	130
Number of retired or separated participants receiving benefits	2015-11-01	0
Number of other retired or separated participants entitled to future benefits	2015-11-01	0
Total of all active and inactive participants	2015-11-01	130
Total participants	2015-11-01	130
Total participants, beginning-of-year	2015-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	121
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	121
2014: CHICAGO DRYER CO. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	131
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	131
2013: CHICAGO DRYER CO. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	137
Total of all active and inactive participants	2013-01-01	137
2012: CHICAGO DRYER CO. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	132
Total of all active and inactive participants	2012-01-01	132

Form 5500 Responses for CHICAGO DRYER CO.

2022: CHICAGO DRYER CO. 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CHICAGO DRYER CO. 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CHICAGO DRYER CO. 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: CHICAGO DRYER CO. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CHICAGO DRYER CO. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CHICAGO DRYER CO. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CHICAGO DRYER CO. 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2015: CHICAGO DRYER CO. 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CHICAGO DRYER CO. 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: CHICAGO DRYER CO. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: CHICAGO DRYER CO. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF026190

Policy instance

Insurance contract or identification number	VF026190
Number of Individuals Covered	169
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,750
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,750
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

276430

Policy instance

Insurance contract or identification number	276430
Number of Individuals Covered	217
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $68,430
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $68,430
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

VF026190

Policy instance

Insurance contract or identification number	VF026190
Number of Individuals Covered	161
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,005
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,005
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

276430

Policy instance

Insurance contract or identification number	276430
Number of Individuals Covered	233
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $68,794
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $68,794
Insurance broker organization code?	3

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

256641

Policy instance

Insurance contract or identification number	256641
Number of Individuals Covered	135
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $78,262
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,873,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,262
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	252
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $12,966
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $264,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,966
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	33
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,789
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,789
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	57
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,416
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,416
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	175
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,122
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,122
Insurance broker organization code?	3

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	49
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,122
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,122
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	31
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,536
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,536
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	61
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,704
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $298,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,704
Insurance broker organization code?	3

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

256641

Policy instance

Insurance contract or identification number	256641
Number of Individuals Covered	127
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $70,448
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,409,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,448
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	155
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,066
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,066
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF IL LLC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	39
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $985
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $985
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF IL LLC

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	26
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,276
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,276
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF IL LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	52
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,991
Total amount of fees paid to insurance company	USD $15
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $305,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,991
Amount paid for insurance broker fees	15
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF IL LLC

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

256641

Policy instance

Insurance contract or identification number	256641
Number of Individuals Covered	117
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $69,083
Total amount of fees paid to insurance company	USD $119
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,727,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,083
Amount paid for insurance broker fees	119
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF ILL LLC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F020497

Policy instance

Insurance contract or identification number	F020497
Number of Individuals Covered	98
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $330
Total amount of fees paid to insurance company	USD $110
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	38
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $973
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $973
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICES LLC

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,791
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,791
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICES LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	51
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,928
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $259,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,928
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

256641

Policy instance

Insurance contract or identification number	256641
Number of Individuals Covered	118
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $71,155
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,423,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,155
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

256641

Policy instance

Insurance contract or identification number	256641
Number of Individuals Covered	116
Insurance policy start date	2015-11-01
Insurance policy end date	2016-10-31
Total amount of commissions paid to insurance broker	USD $65,867
Total amount of fees paid to insurance company	USD $968
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,315,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,867
Amount paid for insurance broker fees	968
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	14
Insurance policy start date	2015-11-01
Insurance policy end date	2016-10-31
Total amount of commissions paid to insurance broker	USD $14,669
Total amount of fees paid to insurance company	USD $124
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $285,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,669
Amount paid for insurance broker fees	124
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

632068

Policy instance

Insurance contract or identification number	632068
Number of Individuals Covered	14
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $10,257
Total amount of fees paid to insurance company	USD $282
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $228,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,257
Amount paid for insurance broker fees	282
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

R6641

Policy instance

Insurance contract or identification number	R6641
Number of Individuals Covered	107
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $63,428
Total amount of fees paid to insurance company	USD $1,058
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,250,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,428
Amount paid for insurance broker fees	1058
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

R6641

Policy instance

Insurance contract or identification number	R6641
Number of Individuals Covered	118
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $59,430
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,985
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

R6641

Policy instance

Insurance contract or identification number	R6641
Number of Individuals Covered	13
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Insurance broker organization code?	3
Insurance broker name	AMERICAN WESTBROOK INS SERVICE

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

R6641

Policy instance

Insurance contract or identification number	R6641
Number of Individuals Covered	16
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Insurance broker organization code?	3
Insurance broker name	NATIONAL BUSINESS PARTNERS

HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )

Policy contract number

R6641

Policy instance

Insurance contract or identification number	R6641
Number of Individuals Covered	121
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $55,148
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,148
Insurance broker organization code?	3
Insurance broker name	NATIONAL BUSINESS PARTNERS

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

B08245

Policy instance

Insurance contract or identification number	B08245
Number of Individuals Covered	132
Insurance policy start date	2011-09-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $57,841
Total amount of fees paid to insurance company	USD $1,043
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,841
Amount paid for insurance broker fees	1043
Insurance broker organization code?	3
Insurance broker name	NATINOAL BUSINESS PARTNERS

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Company Name:	CHICAGO DRYER COMPANY
Employer identification number (EIN):	360899050
NAIC Classification:	333310