NBI, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NBI, INC. EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for NBI, INC. EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: NBI, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 97 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 97 |
| 2021: NBI, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 113 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 113 |
| 2020: NBI, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 112 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 112 |
| 2019: NBI, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 117 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 117 |
| 2018: NBI, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 114 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 114 |
| 2017: NBI, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 114 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 114 |
| 2016: NBI, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 121 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 121 |
| 2015: NBI, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 118 |
| 2014: NBI, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 116 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 116 |
| 2013: NBI, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 109 |
| Total of all active and inactive participants | 2013-01-01 | 109 |
| 2012: NBI, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 105 |
| Total of all active and inactive participants | 2012-01-01 | 105 |
| 2009: NBI, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 94 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 94 |
| Measure | Date | Value |
|---|
| 2022 : NBI, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $0 |
| Total plan assets at beginning of year | 2022-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $0 |
| 2021 : NBI, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| 2020 : NBI, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $0 |
| Total plan assets at end of year | 2020-12-31 | $0 |
| Total plan assets at beginning of year | 2020-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $0 |
| 2019 : NBI, INC. EMPLOYEE BENEFIT PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $0 |
| Total plan assets at end of year | 2019-12-31 | $0 |
| Total plan assets at beginning of year | 2019-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
| 2018 : NBI, INC. EMPLOYEE BENEFIT PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $0 |
| Total plan assets at end of year | 2018-12-31 | $0 |
| Total plan assets at beginning of year | 2018-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $0 |
| 2017 : NBI, INC. EMPLOYEE BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $0 |
| Total plan assets at end of year | 2017-12-31 | $0 |
| Total plan assets at beginning of year | 2017-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| 2016 : NBI, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $0 |
| Total plan assets at end of year | 2016-12-31 | $0 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| 2015 : NBI, INC. EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $0 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| 2014 : NBI, INC. EMPLOYEE BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $0 |
| Total plan assets at end of year | 2014-12-31 | $0 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| 2013 : NBI, INC. EMPLOYEE BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $0 |
| Total plan assets at end of year | 2013-12-31 | $0 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| 2012 : NBI, INC. EMPLOYEE BENEFIT PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $0 |
| Total plan assets at end of year | 2012-12-31 | $0 |
| Total plan assets at beginning of year | 2012-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $0 |
| 2022: NBI, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: NBI, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: NBI, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: NBI, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: NBI, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: NBI, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: NBI, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: NBI, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: NBI, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: NBI, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: NBI, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: NBI, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,172 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $87,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,276 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $415 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $415 | | Additional information about fees paid to insurance broker | AGENT/BROKER SERVICES | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $451,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 00418 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 00418 00000 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,258 | | 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 $3,258 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 00418 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 00418 00000 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,144 | | 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 $3,144 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $442,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $475 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $385 | | Additional information about fees paid to insurance broker | AGENT/BROKER SERVICES | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $14,288 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $86,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,659 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 00418 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 00418 00000 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,917 | | 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 $3,917 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $437,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $497 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $497 | | Additional information about fees paid to insurance broker | AGENT/BROKER SERVICES | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,554 | | Total amount of fees paid to insurance company | USD $1,286 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $84,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,554 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1286 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 00418 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 00418 00000 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,654 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,654 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $474,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $334 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $334 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $12,446 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $82,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,446 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $11,264 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $75,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,264 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $502 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,245 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $502 | | Insurance broker organization code? | 3 |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $414,809 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,429 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,429 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 245603 |
| Policy instance | 4 |
| Insurance contract or identification number | 245603 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,514 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE BASIS AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $73,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,514 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98691991001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98691991001 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $518 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $518 | | Insurance broker organization code? | 3 | | Insurance broker name | RJF, A MARSH & MCLENNAN AGENCY, LLC |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 2 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $338,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,435 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,708 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,435 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
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| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,798 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,798 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 454-4280-00, 03 |
| Policy instance | 2 |
| Insurance contract or identification number | 454-4280-00, 03 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $10,352 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOL LIFE/VOL DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $69,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,352 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 3 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $222,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9869199 |
| Policy instance | 4 |
| Insurance contract or identification number | 9869199 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $451 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $451 | | Insurance broker organization code? | 3 | | Insurance broker name | RJF, A MARSH & MCLENNAN AGENCY, LLC |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,905 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,905 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY, LLC |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 454-4280-00, 03 |
| Policy instance | 2 |
| Insurance contract or identification number | 454-4280-00, 03 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,955 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOL LIFE/VOL DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $66,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,924 | | Insurance broker organization code? | 3 | | Insurance broker name | RJF AGENCIES, INC. |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 3 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $210,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9869199 |
| Policy instance | 4 |
| Insurance contract or identification number | 9869199 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $358 | | Vision 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 $358 | | Insurance broker organization code? | 3 | | Insurance broker name | RJF, A MARSH & MCLENNAN AGENCY, LLC |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,226 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,226 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 454-4280-00, 03 |
| Policy instance | 2 |
| Insurance contract or identification number | 454-4280-00, 03 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOL LIFE/VOL DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $59,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | RJF AGENCIES, INC. |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 3 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $174,956 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9869199 |
| Policy instance | 4 |
| Insurance contract or identification number | 9869199 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $322 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $265 | | Insurance broker organization code? | 3 | | Insurance broker name | TRION, MARSH & MCLENNAN AGENCY, LLC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05750942 |
| Policy instance | 3 |
| Insurance contract or identification number | KM05750942 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $247 | | Total amount of fees paid to insurance company | USD $26 | | 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 $247 | | Amount paid for insurance broker fees | 26 | | Additional information about fees paid to insurance broker | BASE COMMISSIONS NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 037005030080 |
| Policy instance | 4 |
| Insurance contract or identification number | 037005030080 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $174,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 454-4280-00, 03 |
| Policy instance | 2 |
| Insurance contract or identification number | 454-4280-00, 03 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $6,699 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOL LIFE/VOL DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $51,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,699 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
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| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 23808-01017 |
| Policy instance | 1 |
| Insurance contract or identification number | 23808-01017 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,923 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,923 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY |
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