PLASSER AMERICAN CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM
401k plan membership statisitcs for PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM
| Measure | Date | Value |
|---|
| 2022: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-09-01 | 361 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-09-01 | 356 |
| Number of retired or separated participants receiving benefits | 2022-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-09-01 | 0 |
| Total of all active and inactive participants | 2022-09-01 | 356 |
| Number of employers contributing to the scheme | 2022-09-01 | 0 |
| 2021: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 294 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 361 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 361 |
| Number of employers contributing to the scheme | 2021-09-01 | 0 |
| 2020: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 342 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 294 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 294 |
| Number of employers contributing to the scheme | 2020-09-01 | 0 |
| 2019: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 313 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 29 |
| Total of all active and inactive participants | 2019-09-01 | 342 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-09-01 | 0 |
| Total participants | 2019-09-01 | 342 |
| Number of participants with account balances | 2019-09-01 | 313 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-09-01 | 8 |
| 2018: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 246 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 285 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 12 |
| Total of all active and inactive participants | 2018-09-01 | 298 |
| Total participants | 2018-09-01 | 298 |
| Number of participants with account balances | 2018-09-01 | 246 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-09-01 | 5 |
| 2017: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 245 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 11 |
| Total of all active and inactive participants | 2017-09-01 | 257 |
| Total participants | 2017-09-01 | 257 |
| Number of participants with account balances | 2017-09-01 | 246 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-09-01 | 4 |
| 2016: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 239 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 249 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 3 |
| Total of all active and inactive participants | 2016-09-01 | 255 |
| Total participants | 2016-09-01 | 255 |
| Number of participants with account balances | 2016-09-01 | 252 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-09-01 | 2 |
| 2015: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 264 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 237 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 17 |
| Total of all active and inactive participants | 2015-09-01 | 256 |
| Total participants | 2015-09-01 | 256 |
| Number of participants with account balances | 2015-09-01 | 239 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-09-01 | 3 |
| 2014: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 267 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 258 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 4 |
| Total of all active and inactive participants | 2014-09-01 | 264 |
| Total participants | 2014-09-01 | 264 |
| 2013: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 262 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 259 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 4 |
| Total of all active and inactive participants | 2013-09-01 | 267 |
| Total participants | 2013-09-01 | 267 |
| 2012: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 256 |
| Number of retired or separated participants receiving benefits | 2012-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2012-09-01 | 4 |
| Total of all active and inactive participants | 2012-09-01 | 262 |
| Total participants | 2012-09-01 | 262 |
| 2011: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 249 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 8 |
| Total of all active and inactive participants | 2011-09-01 | 257 |
| Total participants | 2011-09-01 | 257 |
| 2010: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 237 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 248 |
| Number of retired or separated participants receiving benefits | 2010-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2010-09-01 | 3 |
| Total of all active and inactive participants | 2010-09-01 | 253 |
| Total participants | 2010-09-01 | 253 |
| 2009: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 233 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2009-09-01 | 2 |
| Total of all active and inactive participants | 2009-09-01 | 237 |
| Total participants | 2009-09-01 | 237 |
| 2022: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Submission has been amended | Yes |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PLASSER AMERICAN CORPORATION EMPLOYEES' GROUP INSURANCE PROGRAM 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0BV3Y |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0BV3Y | | Number of Individuals Covered | 356 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,737 | | Total amount of fees paid to insurance company | USD $14,550 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $323,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,737 | | Amount paid for insurance broker fees | 14550 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| LEGAL SERVICES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | PLASSER |
| Policy instance | 3 |
| Insurance contract or identification number | PLASSER | | Number of Individuals Covered | 130 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $32,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR050527 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR050527 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $3,418 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $28,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,418 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 1 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 324 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $498 | | Total amount of fees paid to insurance company | USD $103 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 1 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 361 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $498 | | Total amount of fees paid to insurance company | USD $49 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR050527 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR050527 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $3,471 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $27,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,471 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LEGAL SERVICES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | PLASSER |
| Policy instance | 3 |
| Insurance contract or identification number | PLASSER | | Number of Individuals Covered | 129 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $31,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0BV3Y |
| Policy instance | 4 |
| Insurance contract or identification number | GLTD0BV3Y | | Number of Individuals Covered | 361 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $15,924 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $259,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,924 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | PLASSER |
| Policy instance | 4 |
| Insurance contract or identification number | PLASSER | | Number of Individuals Covered | 137 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $32,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 522954 |
| Policy instance | 3 |
| Insurance contract or identification number | 522954 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,974 | | Total amount of fees paid to insurance company | USD $10,064 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $261,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,974 | | Amount paid for insurance broker fees | 10064 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR050527 |
| Policy instance | 2 |
| Insurance contract or identification number | VAR050527 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $2,986 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $22,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,986 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 1 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $547 | | Total amount of fees paid to insurance company | USD $49 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00522954 |
| Policy instance | 6 |
| Insurance contract or identification number | 00522954 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $9,701 | | Total amount of fees paid to insurance company | USD $5,662 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $227,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,701 | | Amount paid for insurance broker fees | 5662 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 |
|
| LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 116 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Other welfare benefits provided | LEGAL INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $35,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 050527 |
| Policy instance | 4 |
| Insurance contract or identification number | VAR 050527 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $3,052 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $23,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,052 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 3 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $547 | | Total amount of fees paid to insurance company | USD $56 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 48 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 9933105 |
| Policy instance | 2 |
| Insurance contract or identification number | 9933105 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,614 | | Dental 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 $2,614 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 43663 |
| Policy instance | 1 |
| Insurance contract or identification number | 43663 | | Number of Individuals Covered | 540 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $863,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 9933105 |
| Policy instance | 2 |
| Insurance contract or identification number | 9933105 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,553 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,553 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 3 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $498 | | Total amount of fees paid to insurance company | USD $64 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 6 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISIONS SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 050527 |
| Policy instance | 4 |
| Insurance contract or identification number | VAR 050527 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $2,860 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $21,099 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,860 | | Insurance broker organization code? | 3 |
|
| LEGAL SERVICES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 128 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Other welfare benefits provided | LEGAL INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $25,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00522954 |
| Policy instance | 6 |
| Insurance contract or identification number | 00522954 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $11,810 | | Total amount of fees paid to insurance company | USD $9,206 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $235,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,810 | | Amount paid for insurance broker fees | 9206 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 43663 |
| Policy instance | 1 |
| Insurance contract or identification number | 43663 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $695,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 43663 |
| Policy instance | 1 |
| Insurance contract or identification number | 43663 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $638,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 050527 |
| Policy instance | 3 |
| Insurance contract or identification number | VAR 050527 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $2,865 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $21,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LEGAL SERVICES (National Association of Insurance Commissioners NAIC id number: 48402 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 97 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Other welfare benefits provided | LEGAL INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $20,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 993105 |
| Policy instance | 5 |
| Insurance contract or identification number | 993105 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-01 | | Total amount of commissions paid to insurance broker | USD $2,596 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $157,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00522954 |
| Policy instance | 6 |
| Insurance contract or identification number | 00522954 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $14,037 | | Total amount of fees paid to insurance company | USD $8,789 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $256,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 42571 |
| Policy instance | 2 |
| Insurance contract or identification number | 42571 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $586 | | Total amount of fees paid to insurance company | USD $61 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,796 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
