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EDUCATIONAL DATA SYSTEMS, INC. 401k Plan overview

Plan NameEDUCATIONAL DATA SYSTEMS, INC.
Plan identification number 501

EDUCATIONAL DATA SYSTEMS, INC. Benefits

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

401k Sponsoring company profile

EDUCATIONAL DATA SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name:EDUCATIONAL DATA SYSTEMS, INC.
Employer identification number (EIN):382272565
NAIC Classification:611000

Additional information about EDUCATIONAL DATA SYSTEMS, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2016-08-02
Company Identification Number: 123652091
Legal Registered Office Address: 3330 NE KNOTT ST

PORTLAND
United States of America (USA)
97212

More information about EDUCATIONAL DATA SYSTEMS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EDUCATIONAL DATA SYSTEMS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01ROBERT DANCER2023-06-19
5012021-01-01ROBERT DANCER2022-03-28
5012020-01-01ROBERT DANCER2021-05-27
5012019-01-01ROBERT DANCER2020-04-20
5012018-01-01
5012017-01-01
5012016-08-01
5012015-08-01ROBERT DANCER
5012014-08-01ROBERT DANCER
5012013-08-01ROBERT DANCER
5012012-08-01ROBERT DANCER
5012011-08-01ROBERT DANCER
5012010-08-01ROBERT DANCER
5012009-08-01ROBERT DANCER
5012008-08-01ROBERT DANCER
5012007-08-01ROBERT DANCER
5012006-08-01ROBERT DANCER
5012005-08-01ROBERT DANCER
5012004-08-01ROBERT DANCER
5012003-08-01ROBERT DANCER
5012002-08-01ROBERT DANCER
5012001-08-01ROBERT DANCER
5012000-08-01ROBERT DANCER
5011999-08-01ROBERT DANCER
5011998-08-01ROBERT DANCER

Plan Statistics for EDUCATIONAL DATA SYSTEMS, INC.

401k plan membership statisitcs for EDUCATIONAL DATA SYSTEMS, INC.

Measure Date Value
2022: EDUCATIONAL DATA SYSTEMS, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-01821
Total number of active participants reported on line 7a of the Form 55002022-01-01799
Number of retired or separated participants receiving benefits2022-01-017
Number of other retired or separated participants entitled to future benefits2022-01-01132
Total of all active and inactive participants2022-01-01938
Number of employers contributing to the scheme2022-01-010
2021: EDUCATIONAL DATA SYSTEMS, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01831
Total number of active participants reported on line 7a of the Form 55002021-01-01972
Number of retired or separated participants receiving benefits2021-01-0113
Number of other retired or separated participants entitled to future benefits2021-01-0137
Total of all active and inactive participants2021-01-011,022
Number of employers contributing to the scheme2021-01-010
2020: EDUCATIONAL DATA SYSTEMS, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01725
Total number of active participants reported on line 7a of the Form 55002020-01-01787
Number of retired or separated participants receiving benefits2020-01-012
Number of other retired or separated participants entitled to future benefits2020-01-0199
Total of all active and inactive participants2020-01-01888
Number of employers contributing to the scheme2020-01-010
2019: EDUCATIONAL DATA SYSTEMS, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01639
Total number of active participants reported on line 7a of the Form 55002019-01-01724
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0117
Total of all active and inactive participants2019-01-01742
Number of employers contributing to the scheme2019-01-010
2018: EDUCATIONAL DATA SYSTEMS, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01588
Total number of active participants reported on line 7a of the Form 55002018-01-01617
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0122
Total of all active and inactive participants2018-01-01639
Number of employers contributing to the scheme2018-01-010
2017: EDUCATIONAL DATA SYSTEMS, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-01507
Total number of active participants reported on line 7a of the Form 55002017-01-01588
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01588
2016: EDUCATIONAL DATA SYSTEMS, INC. 2016 401k membership
Total participants, beginning-of-year2016-08-01436
Total number of active participants reported on line 7a of the Form 55002016-08-01507
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01507
2015: EDUCATIONAL DATA SYSTEMS, INC. 2015 401k membership
Total participants, beginning-of-year2015-08-01377
Total number of active participants reported on line 7a of the Form 55002015-08-01436
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01436
2014: EDUCATIONAL DATA SYSTEMS, INC. 2014 401k membership
Total participants, beginning-of-year2014-08-01341
Total number of active participants reported on line 7a of the Form 55002014-08-01377
Number of retired or separated participants receiving benefits2014-08-010
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01377
2013: EDUCATIONAL DATA SYSTEMS, INC. 2013 401k membership
Total participants, beginning-of-year2013-08-01316
Total number of active participants reported on line 7a of the Form 55002013-08-01341
Number of retired or separated participants receiving benefits2013-08-010
Number of other retired or separated participants entitled to future benefits2013-08-010
Total of all active and inactive participants2013-08-01341
2012: EDUCATIONAL DATA SYSTEMS, INC. 2012 401k membership
Total participants, beginning-of-year2012-08-01306
Total number of active participants reported on line 7a of the Form 55002012-08-01316
Number of retired or separated participants receiving benefits2012-08-010
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01316
2011: EDUCATIONAL DATA SYSTEMS, INC. 2011 401k membership
Total participants, beginning-of-year2011-08-01346
Total number of active participants reported on line 7a of the Form 55002011-08-01306
Number of retired or separated participants receiving benefits2011-08-010
Number of other retired or separated participants entitled to future benefits2011-08-010
Total of all active and inactive participants2011-08-01306
2010: EDUCATIONAL DATA SYSTEMS, INC. 2010 401k membership
Total participants, beginning-of-year2010-08-01324
Total number of active participants reported on line 7a of the Form 55002010-08-01346
Number of retired or separated participants receiving benefits2010-08-010
Number of other retired or separated participants entitled to future benefits2010-08-010
Total of all active and inactive participants2010-08-01346
2009: EDUCATIONAL DATA SYSTEMS, INC. 2009 401k membership
Total participants, beginning-of-year2009-08-01294
Total number of active participants reported on line 7a of the Form 55002009-08-01380
Number of retired or separated participants receiving benefits2009-08-010
Number of other retired or separated participants entitled to future benefits2009-08-010
Total of all active and inactive participants2009-08-01380
2008: EDUCATIONAL DATA SYSTEMS, INC. 2008 401k membership
Total participants, beginning-of-year2008-08-01380
Total number of active participants reported on line 7a of the Form 55002008-08-01324
Number of retired or separated participants receiving benefits2008-08-010
Number of other retired or separated participants entitled to future benefits2008-08-010
Total of all active and inactive participants2008-08-01324
2007: EDUCATIONAL DATA SYSTEMS, INC. 2007 401k membership
Total participants, beginning-of-year2007-08-01223
Total number of active participants reported on line 7a of the Form 55002007-08-01394
Number of retired or separated participants receiving benefits2007-08-010
Number of other retired or separated participants entitled to future benefits2007-08-010
Total of all active and inactive participants2007-08-01394
2006: EDUCATIONAL DATA SYSTEMS, INC. 2006 401k membership
Total participants, beginning-of-year2006-08-01131
Total number of active participants reported on line 7a of the Form 55002006-08-01223
Number of retired or separated participants receiving benefits2006-08-010
Number of other retired or separated participants entitled to future benefits2006-08-010
Total of all active and inactive participants2006-08-01223
2005: EDUCATIONAL DATA SYSTEMS, INC. 2005 401k membership
Total participants, beginning-of-year2005-08-01123
Total number of active participants reported on line 7a of the Form 55002005-08-01131
Number of retired or separated participants receiving benefits2005-08-010
Number of other retired or separated participants entitled to future benefits2005-08-010
Total of all active and inactive participants2005-08-01131
2004: EDUCATIONAL DATA SYSTEMS, INC. 2004 401k membership
Total participants, beginning-of-year2004-08-01112
Total number of active participants reported on line 7a of the Form 55002004-08-01123
Number of retired or separated participants receiving benefits2004-08-010
Number of other retired or separated participants entitled to future benefits2004-08-010
Total of all active and inactive participants2004-08-01123
2003: EDUCATIONAL DATA SYSTEMS, INC. 2003 401k membership
Total participants, beginning-of-year2003-08-01119
Total number of active participants reported on line 7a of the Form 55002003-08-01112
Number of retired or separated participants receiving benefits2003-08-010
Number of other retired or separated participants entitled to future benefits2003-08-010
Total of all active and inactive participants2003-08-01112
2002: EDUCATIONAL DATA SYSTEMS, INC. 2002 401k membership
Total participants, beginning-of-year2002-08-01135
Total number of active participants reported on line 7a of the Form 55002002-08-01119
Number of retired or separated participants receiving benefits2002-08-010
Number of other retired or separated participants entitled to future benefits2002-08-010
Total of all active and inactive participants2002-08-01119
2001: EDUCATIONAL DATA SYSTEMS, INC. 2001 401k membership
Total participants, beginning-of-year2001-08-01158
Total number of active participants reported on line 7a of the Form 55002001-08-01135
Number of retired or separated participants receiving benefits2001-08-010
Number of other retired or separated participants entitled to future benefits2001-08-010
Total of all active and inactive participants2001-08-01135
2000: EDUCATIONAL DATA SYSTEMS, INC. 2000 401k membership
Total participants, beginning-of-year2000-08-01111
Total number of active participants reported on line 7a of the Form 55002000-08-01158
Number of retired or separated participants receiving benefits2000-08-010
Number of other retired or separated participants entitled to future benefits2000-08-010
Total of all active and inactive participants2000-08-01158
1999: EDUCATIONAL DATA SYSTEMS, INC. 1999 401k membership
Total participants, beginning-of-year1999-08-01111
Total number of active participants reported on line 7a of the Form 55001999-08-01111
Number of retired or separated participants receiving benefits1999-08-010
Number of other retired or separated participants entitled to future benefits1999-08-010
Total of all active and inactive participants1999-08-01111
1998: EDUCATIONAL DATA SYSTEMS, INC. 1998 401k membership
Total participants, beginning-of-year1998-08-01100
Total number of active participants reported on line 7a of the Form 55001998-08-01100
Number of retired or separated participants receiving benefits1998-08-010
Number of other retired or separated participants entitled to future benefits1998-08-010
Total of all active and inactive participants1998-08-01100

Form 5500 Responses for EDUCATIONAL DATA SYSTEMS, INC.

2022: EDUCATIONAL DATA SYSTEMS, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: EDUCATIONAL DATA SYSTEMS, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: EDUCATIONAL DATA SYSTEMS, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: EDUCATIONAL DATA SYSTEMS, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: EDUCATIONAL DATA SYSTEMS, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: EDUCATIONAL DATA SYSTEMS, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: EDUCATIONAL DATA SYSTEMS, INC. 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – General assets of the sponsorYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – General assets of the sponsorYes
2015: EDUCATIONAL DATA SYSTEMS, INC. 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: EDUCATIONAL DATA SYSTEMS, INC. 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: EDUCATIONAL DATA SYSTEMS, INC. 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: EDUCATIONAL DATA SYSTEMS, INC. 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: EDUCATIONAL DATA SYSTEMS, INC. 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2010: EDUCATIONAL DATA SYSTEMS, INC. 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Submission has been amendedNo
2010-08-01This submission is the final filingNo
2010-08-01This return/report is a short plan year return/report (less than 12 months)No
2010-08-01Plan is a collectively bargained planNo
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – InsuranceYes
2009: EDUCATIONAL DATA SYSTEMS, INC. 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes
2008: EDUCATIONAL DATA SYSTEMS, INC. 2008 form 5500 responses
2008-08-01Type of plan entitySingle employer plan
2008-08-01Submission has been amendedNo
2008-08-01This submission is the final filingNo
2008-08-01This return/report is a short plan year return/report (less than 12 months)No
2008-08-01Plan is a collectively bargained planNo
2008-08-01Plan funding arrangement – InsuranceYes
2008-08-01Plan benefit arrangement – InsuranceYes
2007: EDUCATIONAL DATA SYSTEMS, INC. 2007 form 5500 responses
2007-08-01Type of plan entitySingle employer plan
2007-08-01Submission has been amendedNo
2007-08-01This submission is the final filingNo
2007-08-01This return/report is a short plan year return/report (less than 12 months)No
2007-08-01Plan is a collectively bargained planNo
2007-08-01Plan funding arrangement – InsuranceYes
2007-08-01Plan benefit arrangement – InsuranceYes
2006: EDUCATIONAL DATA SYSTEMS, INC. 2006 form 5500 responses
2006-08-01Type of plan entitySingle employer plan
2006-08-01Submission has been amendedNo
2006-08-01This submission is the final filingNo
2006-08-01This return/report is a short plan year return/report (less than 12 months)No
2006-08-01Plan is a collectively bargained planNo
2006-08-01Plan funding arrangement – InsuranceYes
2006-08-01Plan benefit arrangement – InsuranceYes
2005: EDUCATIONAL DATA SYSTEMS, INC. 2005 form 5500 responses
2005-08-01Type of plan entitySingle employer plan
2005-08-01Submission has been amendedNo
2005-08-01This submission is the final filingNo
2005-08-01This return/report is a short plan year return/report (less than 12 months)No
2005-08-01Plan is a collectively bargained planNo
2005-08-01Plan funding arrangement – InsuranceYes
2005-08-01Plan benefit arrangement – InsuranceYes
2004: EDUCATIONAL DATA SYSTEMS, INC. 2004 form 5500 responses
2004-08-01Type of plan entitySingle employer plan
2004-08-01Submission has been amendedNo
2004-08-01This submission is the final filingNo
2004-08-01This return/report is a short plan year return/report (less than 12 months)No
2004-08-01Plan is a collectively bargained planNo
2004-08-01Plan funding arrangement – InsuranceYes
2004-08-01Plan benefit arrangement – InsuranceYes
2003: EDUCATIONAL DATA SYSTEMS, INC. 2003 form 5500 responses
2003-08-01Type of plan entitySingle employer plan
2003-08-01Submission has been amendedNo
2003-08-01This submission is the final filingNo
2003-08-01This return/report is a short plan year return/report (less than 12 months)No
2003-08-01Plan is a collectively bargained planNo
2003-08-01Plan funding arrangement – InsuranceYes
2003-08-01Plan benefit arrangement – InsuranceYes
2002: EDUCATIONAL DATA SYSTEMS, INC. 2002 form 5500 responses
2002-08-01Type of plan entitySingle employer plan
2002-08-01Submission has been amendedNo
2002-08-01This submission is the final filingNo
2002-08-01This return/report is a short plan year return/report (less than 12 months)No
2002-08-01Plan is a collectively bargained planNo
2002-08-01Plan funding arrangement – InsuranceYes
2002-08-01Plan benefit arrangement – InsuranceYes
2001: EDUCATIONAL DATA SYSTEMS, INC. 2001 form 5500 responses
2001-08-01Type of plan entitySingle employer plan
2001-08-01Submission has been amendedNo
2001-08-01This submission is the final filingNo
2001-08-01This return/report is a short plan year return/report (less than 12 months)No
2001-08-01Plan is a collectively bargained planNo
2001-08-01Plan funding arrangement – InsuranceYes
2001-08-01Plan benefit arrangement – InsuranceYes
2000: EDUCATIONAL DATA SYSTEMS, INC. 2000 form 5500 responses
2000-08-01Type of plan entitySingle employer plan
2000-08-01Submission has been amendedNo
2000-08-01This submission is the final filingNo
2000-08-01This return/report is a short plan year return/report (less than 12 months)No
2000-08-01Plan is a collectively bargained planNo
2000-08-01Plan funding arrangement – InsuranceYes
2000-08-01Plan benefit arrangement – InsuranceYes
1999: EDUCATIONAL DATA SYSTEMS, INC. 1999 form 5500 responses
1999-08-01Type of plan entitySingle employer plan
1999-08-01Submission has been amendedNo
1999-08-01This submission is the final filingNo
1999-08-01This return/report is a short plan year return/report (less than 12 months)No
1999-08-01Plan is a collectively bargained planNo
1999-08-01Plan funding arrangement – InsuranceYes
1999-08-01Plan benefit arrangement – InsuranceYes
1998: EDUCATIONAL DATA SYSTEMS, INC. 1998 form 5500 responses
1998-08-01Type of plan entitySingle employer plan
1998-08-01First time form 5500 has been submittedYes
1998-08-01Submission has been amendedNo
1998-08-01This submission is the final filingNo
1998-08-01This return/report is a short plan year return/report (less than 12 months)No
1998-08-01Plan is a collectively bargained planNo
1998-08-01Plan funding arrangement – InsuranceYes
1998-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969181
Policy instance 2
Insurance contract or identification numberFLX969181
Number of Individuals Covered799
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $55,019
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $346,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $55,019
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered891
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,557
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,557
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969181
Policy instance 2
Insurance contract or identification numberFLX969181
Number of Individuals Covered972
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $39,487
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $283,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $39,487
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered870
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,457
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,457
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969181
Policy instance 2
Insurance contract or identification numberFLX969181
Number of Individuals Covered711
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $23,798
Total amount of fees paid to insurance companyUSD $3,872
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $158,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,798
Amount paid for insurance broker fees3872
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered840
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,042
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,042
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10222917
Policy instance 3
Insurance contract or identification number10222917
Number of Individuals Covered726
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $24,470
Total amount of fees paid to insurance companyUSD $857
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $163,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,470
Amount paid for insurance broker fees857
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number5307
Policy instance 2
Insurance contract or identification number5307
Number of Individuals Covered884
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $19,334
Total amount of fees paid to insurance companyUSD $422
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,334
Amount paid for insurance broker fees422
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered759
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,265
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,265
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10222917
Policy instance 4
Insurance contract or identification number10222917
Number of Individuals Covered618
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $25,695
Total amount of fees paid to insurance companyUSD $1,574
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $171,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,695
Amount paid for insurance broker fees1574
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberD3110
Policy instance 3
Insurance contract or identification numberD3110
Number of Individuals Covered617
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number5307
Policy instance 2
Insurance contract or identification number5307
Number of Individuals Covered652
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $16,260
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,260
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered571
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,881
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,881
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010222918
Policy instance 6
Insurance contract or identification number000010222918
Number of Individuals Covered588
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $23,606
Total amount of fees paid to insurance companyUSD $9,206
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $157,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,606
Amount paid for insurance broker fees9206
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberD3110
Policy instance 5
Insurance contract or identification numberD3110
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,444
Total amount of fees paid to insurance companyUSD $44
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $18,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $378
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
Insurance broker nameEVELYN WASHCHUK AND VARIOUS AGENTS
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNCK92
Policy instance 4
Insurance contract or identification numberNCK92
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $56
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $28
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameBRIAN WHITE
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number7290
Policy instance 3
Insurance contract or identification number7290
Number of Individuals Covered28
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $385
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameEDWARD O WALTER & VARIOUS AGENTS
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number5307
Policy instance 2
Insurance contract or identification number5307
Number of Individuals Covered553
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,230
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,230
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97487321001
Policy instance 1
Insurance contract or identification number97487321001
Number of Individuals Covered471
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,001
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,001
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameHYLANT GROUP, INC.

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