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UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 401k Plan overview

Plan NameUPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN
Plan identification number 505

UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN Benefits

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

401k Sponsoring company profile

UMI COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:UMI COMPANY, INC.
Employer identification number (EIN):411397026
NAIC Classification:332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052021-10-01BRIAN BEICH2023-02-20
5052020-10-01BRIAN BEICH2022-04-06
5052019-10-01BRIAN BEICH2021-03-11
5052018-10-01BRIAN BEICH2020-04-08
5052017-10-01
5052016-10-01BRIAN BEICH
5052015-10-01BRIAN BEICH
5052014-10-01BRIAN BEICH
5052013-10-01BRIAN BEICH
5052012-10-01BRIAN BEICH
5052011-10-01BRIAN C BEICH
5052010-10-01BRIAN BEICH
5052009-10-01BRIAN BEICH

Plan Statistics for UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN

401k plan membership statisitcs for UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN

Measure Date Value
2021: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01160
Total number of active participants reported on line 7a of the Form 55002021-10-01173
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01173
Number of employers contributing to the scheme2021-10-010
2020: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01134
Total number of active participants reported on line 7a of the Form 55002020-10-01160
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01160
Number of employers contributing to the scheme2020-10-010
2019: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01160
Total number of active participants reported on line 7a of the Form 55002019-10-01134
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01134
Number of employers contributing to the scheme2019-10-010
2018: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01145
Total number of active participants reported on line 7a of the Form 55002018-10-01160
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01160
Number of employers contributing to the scheme2018-10-010
2017: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01233
Total number of active participants reported on line 7a of the Form 55002017-10-01145
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01145
Number of employers contributing to the scheme2017-10-010
2016: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01223
Total number of active participants reported on line 7a of the Form 55002016-10-01233
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01233
2015: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01223
Total number of active participants reported on line 7a of the Form 55002015-10-01226
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01226
2014: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01204
Total number of active participants reported on line 7a of the Form 55002014-10-01223
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01223
2013: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01188
Total number of active participants reported on line 7a of the Form 55002013-10-01204
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01204
2012: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01194
Total number of active participants reported on line 7a of the Form 55002012-10-01188
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01188
2011: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01177
Total number of active participants reported on line 7a of the Form 55002011-10-01194
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01194
2010: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01172
Total number of active participants reported on line 7a of the Form 55002010-10-01177
Number of retired or separated participants receiving benefits2010-10-010
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01177
2009: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01179
Total number of active participants reported on line 7a of the Form 55002009-10-01172
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01172

Form 5500 Responses for UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN

2021: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2010: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan funding arrangement – General assets of the sponsorYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: UPPER MIDWEST INDUSTRIES, INC. FLEXIBLE CONTRIBUTION ACCOUNT PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number308153
Policy instance 2
Insurance contract or identification number308153
Number of Individuals Covered262
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $5,302
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,466,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,302
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 number10119417
Policy instance 1
Insurance contract or identification number10119417
Number of Individuals Covered169
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $1,419
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $52,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,419
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 number10119417
Policy instance 3
Insurance contract or identification number10119417
Number of Individuals Covered141
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $1,521
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $47,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,521
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number918928
Policy instance 2
Insurance contract or identification number918928
Number of Individuals Covered249
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
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 $1,285,158
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 number308153
Policy instance 1
Insurance contract or identification number308153
Number of Individuals Covered173
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $2,337
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $49,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,337
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number308153
Policy instance 2
Insurance contract or identification number308153
Number of Individuals Covered303
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,155,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10119417
Policy instance 1
Insurance contract or identification number10119417
Number of Individuals Covered136
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,584
Total amount of fees paid to insurance companyUSD $840
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $40,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,584
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10072765
Policy instance 2
Insurance contract or identification number10072765
Number of Individuals Covered134
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $3,371
Total amount of fees paid to insurance companyUSD $1,375
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $95,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,371
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number918928
Policy instance 1
Insurance contract or identification number918928
Number of Individuals Covered191
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
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 $1,331,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10072766
Policy instance 2
Insurance contract or identification number10072766
Number of Individuals Covered160
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $2,559
Total amount of fees paid to insurance companyUSD $2,367
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $84,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,559
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBROKER BONUS
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )
Policy contract number305096
Policy instance 1
Insurance contract or identification number305096
Number of Individuals Covered247
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,390
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,181,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5390
Additional information about fees paid to insurance brokerBROKER INCENTIVE PROGRAM
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10072765
Policy instance 2
Insurance contract or identification number10072765
Number of Individuals Covered145
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $2,575
Total amount of fees paid to insurance companyUSD $4,883
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $78,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )
Policy contract number305096
Policy instance 1
Insurance contract or identification number305096
Number of Individuals Covered234
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,735
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,323,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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