MERCANTILE THRIFT STORES, INC. has sponsored the creation of one or more 401k plans.
Additional information about MERCANTILE THRIFT STORES, INC.
Submission information for form 5500 for 401k plan MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN
401k plan membership statisitcs for MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN
| Measure | Date | Value |
|---|
| 2022: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 46 |
| Total of all active and inactive participants | 2022-08-01 | 46 |
| Total participants | 2022-08-01 | 46 |
| 2021: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 44 |
| Total of all active and inactive participants | 2021-08-01 | 44 |
| Total participants | 2021-08-01 | 44 |
| 2020: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 41 |
| Total of all active and inactive participants | 2020-08-01 | 41 |
| Total participants | 2020-08-01 | 41 |
| 2018: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 57 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 47 |
| Total of all active and inactive participants | 2018-08-01 | 47 |
| Total participants | 2018-08-01 | 47 |
| 2017: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 56 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 57 |
| Total of all active and inactive participants | 2017-08-01 | 57 |
| Total participants | 2017-08-01 | 57 |
| 2016: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 61 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 56 |
| Total of all active and inactive participants | 2016-08-01 | 56 |
| Total participants | 2016-08-01 | 56 |
| 2015: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 61 |
| Total of all active and inactive participants | 2015-08-01 | 61 |
| Total participants | 2015-08-01 | 0 |
| 2014: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 94 |
| Total of all active and inactive participants | 2014-08-01 | 94 |
| Total participants | 2014-08-01 | 0 |
| 2013: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 77 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 118 |
| Total of all active and inactive participants | 2013-08-01 | 118 |
| Total participants | 2013-08-01 | 0 |
| 2012: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 80 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 77 |
| Total of all active and inactive participants | 2012-08-01 | 77 |
| Total participants | 2012-08-01 | 0 |
| 2011: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 80 |
| Total of all active and inactive participants | 2011-08-01 | 80 |
| Total participants | 2011-08-01 | 80 |
| 2010: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-08-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-08-01 | 78 |
| Total of all active and inactive participants | 2010-08-01 | 78 |
| Total participants | 2010-08-01 | 78 |
| 2009: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 82 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 78 |
| Total of all active and inactive participants | 2009-08-01 | 78 |
| Total participants | 2009-08-01 | 78 |
| Measure | Date | Value |
|---|
| 2023 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2023 401k financial data |
|---|
| Total income from all sources | 2023-07-31 | $29,687 |
| Expenses. Total of all expenses incurred | 2023-07-31 | $29,687 |
| Benefits paid (including direct rollovers) | 2023-07-31 | $29,687 |
| Total contributions received or receivable from participants | 2023-07-31 | $29,687 |
| 2022 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-07-31 | $27,473 |
| Expenses. Total of all expenses incurred | 2022-07-31 | $27,473 |
| Benefits paid (including direct rollovers) | 2022-07-31 | $27,473 |
| Total contributions received or receivable from participants | 2022-07-31 | $27,473 |
| 2021 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-07-31 | $25,658 |
| Expenses. Total of all expenses incurred | 2021-07-31 | $25,658 |
| Benefits paid (including direct rollovers) | 2021-07-31 | $25,658 |
| Total contributions received or receivable from participants | 2021-07-31 | $25,658 |
| 2018 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-07-31 | $41,632 |
| Expenses. Total of all expenses incurred | 2018-07-31 | $41,632 |
| Benefits paid (including direct rollovers) | 2018-07-31 | $41,632 |
| Total contributions received or receivable from participants | 2018-07-31 | $41,632 |
| 2017 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-07-31 | $47,154 |
| Expenses. Total of all expenses incurred | 2017-07-31 | $47,154 |
| Benefits paid (including direct rollovers) | 2017-07-31 | $47,154 |
| Total contributions received or receivable from participants | 2017-07-31 | $47,154 |
| 2016 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-07-31 | $62,150 |
| Expenses. Total of all expenses incurred | 2016-07-31 | $62,150 |
| Benefits paid (including direct rollovers) | 2016-07-31 | $62,150 |
| Total contributions received or receivable from participants | 2016-07-31 | $62,150 |
| 2015 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-07-31 | $74,480 |
| Expenses. Total of all expenses incurred | 2015-07-31 | $74,480 |
| Benefits paid (including direct rollovers) | 2015-07-31 | $74,480 |
| Total contributions received or receivable from participants | 2015-07-31 | $74,480 |
| 2014 : MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-07-31 | $76,687 |
| Expenses. Total of all expenses incurred | 2014-07-31 | $76,687 |
| Benefits paid (including direct rollovers) | 2014-07-31 | $76,687 |
| Total contributions received or receivable from participants | 2014-07-31 | $76,687 |
| 2022: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2010 form 5500 responses |
|---|
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Plan funding arrangement – Insurance | Yes |
| 2010-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MERCANTILE THRIFT STORES SECTION 125 PREMIUM ONLY PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 ) |
| Policy contract number | 798899 |
| Policy instance | 2 |
| Insurance contract or identification number | 798899 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $5,640 | | 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 $5,640 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $2,615 | | Dental 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 $2,615 | | Insurance broker organization code? | 3 |
|
| HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 ) |
| Policy contract number | 798899 |
| Policy instance | 2 |
| Insurance contract or identification number | 798899 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $5,640 | | 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 $5,640 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $2,808 | | Dental 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 $2,808 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,621 | | Dental 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 $2,621 | | Insurance broker organization code? | 3 |
|
| HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 ) |
| Policy contract number | 307810/798899 |
| Policy instance | 2 |
| Insurance contract or identification number | 307810/798899 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $5,175 | | 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 $5,175 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $2,976 | | Dental 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 $2,976 | | Insurance broker organization code? | 3 |
|
| HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 ) |
| Policy contract number | 307810 |
| Policy instance | 2 |
| Insurance contract or identification number | 307810 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $6,408 | | 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 $6,408 | | Insurance broker organization code? | 3 |
|
| HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 ) |
| Policy contract number | 307810 |
| Policy instance | 3 |
| Insurance contract or identification number | 307810 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $4,163 | | 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 $4,163 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $3,094 | | Dental 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 $3,094 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717978 |
| Policy instance | 2 |
| Insurance contract or identification number | 717978 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $3,402 | | 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 $3,402 | | Insurance broker organization code? | 3 | | Insurance broker name | CARPENTER ROWLAND BATENBURG CO. INC |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 739510 |
| Policy instance | 2 |
| Insurance contract or identification number | 739510 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $7,602 | | 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 $7,602 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $3,517 | | Dental 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 $3,517 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 739510 |
| Policy instance | 3 |
| Insurance contract or identification number | 739510 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $3,708 | | 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 $3,708 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 347955 |
| Policy instance | 2 |
| Insurance contract or identification number | 347955 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,496 | | 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 $3,496 | | Insurance broker organization code? | 3 | | Insurance broker name | CARPENTER ROWLAND BATENBURG CO., IN |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $3,519 | | Dental 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 $3,519 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1042430 |
| Policy instance | 1 |
| Insurance contract or identification number | 1042430 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $1,631 | | Dental 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 $1,631 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00445859 |
| Policy instance | 3 |
| Insurance contract or identification number | 00445859 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,856 | | Dental 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 $1,838 | | Insurance broker organization code? | 3 | | Insurance broker name | GREAT LAKES INS CONSULT |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 347955 |
| Policy instance | 2 |
| Insurance contract or identification number | 347955 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $9,901 | | 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 $9,488 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 347955 |
| Policy instance | 2 |
| Insurance contract or identification number | 347955 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $10,476 | | 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 $1,016 | | Insurance broker organization code? | 3 | | Insurance broker name | CARPENTER ROWLAND BATENBURG CO. INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00445859 |
| Policy instance | 1 |
| Insurance contract or identification number | 00445859 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $3,452 | | Dental 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 $34 | | Insurance broker organization code? | 3 | | Insurance broker name | CRB INSURANCE, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 347955 |
| Policy instance | 2 |
| Insurance contract or identification number | 347955 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $11,512 | | Health Insurance Welfare Benefit | Yes | | 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 | 00445859 |
| Policy instance | 1 |
| Insurance contract or identification number | 00445859 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $3,583 | | Dental 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 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 347955 |
| Policy instance | 2 |
| Insurance contract or identification number | 347955 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $10,470 | | Health Insurance Welfare Benefit | Yes | | 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 | 00445859 |
| Policy instance | 1 |
| Insurance contract or identification number | 00445859 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $3,452 | | Dental 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 |
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