OAKLAWN JOCKEY CLUB, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN
401k plan membership statisitcs for OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN
| Measure | Date | Value |
|---|
| 2022: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 372 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 373 |
| 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 | 373 |
| 2021: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 337 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 372 |
| Total of all active and inactive participants | 2021-01-01 | 372 |
| 2020: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 401 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 337 |
| Total of all active and inactive participants | 2020-01-01 | 337 |
| 2019: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 360 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 401 |
| Total of all active and inactive participants | 2019-11-01 | 401 |
| 2018: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 319 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 360 |
| Total of all active and inactive participants | 2018-11-01 | 360 |
| 2017: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 299 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 319 |
| Total of all active and inactive participants | 2017-11-01 | 319 |
| 2016: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 299 |
| Total of all active and inactive participants | 2016-11-01 | 299 |
| 2015: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 310 |
| Total of all active and inactive participants | 2015-11-01 | 310 |
| 2014: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 272 |
| Total of all active and inactive participants | 2014-11-01 | 272 |
| 2013: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 219 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 233 |
| Total of all active and inactive participants | 2013-11-01 | 233 |
| 2022: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Submission has been amended | No |
| 2019-11-01 | This submission is the final filing | No |
| 2019-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-11-01 | Plan is a collectively bargained plan | No |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Submission has been amended | No |
| 2018-11-01 | This submission is the final filing | No |
| 2018-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-11-01 | Plan is a collectively bargained plan | No |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Submission has been amended | No |
| 2017-11-01 | This submission is the final filing | No |
| 2017-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-11-01 | Plan is a collectively bargained plan | No |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Submission has been amended | No |
| 2016-11-01 | This submission is the final filing | No |
| 2016-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-11-01 | Plan is a collectively bargained plan | No |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: OAKLAWN JOCKEY CLUB HEALTH AND WELFARE BENEFITS PLAN GROUP COMPREHENSIVE MEDICAL, GROUP DENTAL, GROUP VISION PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | First time form 5500 has been submitted | Yes |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 5 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 580 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061318 |
| Policy instance | 4 |
| Insurance contract or identification number | 061318 | | Number of Individuals Covered | 457 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,548 | | 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 | 00543659 |
| Policy instance | 3 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $14,145 | | Total amount of fees paid to insurance company | USD $7,653 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,145 | | Amount paid for insurance broker fees | 7653 | | Additional information about fees paid to insurance broker | SPC BONUS | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 2 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 523 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 00543659 |
| Policy instance | 1 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $17,172 | | Total amount of fees paid to insurance company | USD $100 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,172 | | Amount paid for insurance broker fees | 100 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00543659 |
| Policy instance | 1 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $17,522 | | Total amount of fees paid to insurance company | USD $2,299 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,522 | | Amount paid for insurance broker fees | 2299 | | Additional information about fees paid to insurance broker | COMMISSION | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 2 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 00543659 |
| Policy instance | 3 |
| Insurance contract or identification number | 00543659 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,323 | | Total amount of fees paid to insurance company | USD $1,617 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,323 | | Amount paid for insurance broker fees | 1617 | | Additional information about fees paid to insurance broker | COMMISSION | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061630 |
| Policy instance | 4 |
| Insurance contract or identification number | 061630 | | Number of Individuals Covered | 465 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 5 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 606 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 5 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 495 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061630 |
| Policy instance | 4 |
| Insurance contract or identification number | 061630 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,596 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,596 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00543659 |
| Policy instance | 3 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $10,461 | | Total amount of fees paid to insurance company | USD $2,162 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,461 | | Amount paid for insurance broker fees | 2162 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 2 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 00543659 |
| Policy instance | 1 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $18,297 | | Total amount of fees paid to insurance company | USD $3,053 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,297 | | Amount paid for insurance broker fees | 3053 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 2 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 506 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 00543659 |
| Policy instance | 3 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,174 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,174 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061630 |
| Policy instance | 4 |
| Insurance contract or identification number | 061630 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $834 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $834 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 5 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 571 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 | 00543659 |
| Policy instance | 1 |
| Insurance contract or identification number | 00543659 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,058 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,058 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 1 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 473 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061630 |
| Policy instance | 2 |
| Insurance contract or identification number | 061630 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $4,443 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,443 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 3 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 523 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 024318 |
| Policy instance | 1 |
| Insurance contract or identification number | 024318 | | Number of Individuals Covered | 403 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027056 |
| Policy instance | 3 |
| Insurance contract or identification number | 027056 | | Number of Individuals Covered | 441 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 000003937V |
| Policy instance | 2 |
| Insurance contract or identification number | 000003937V | | Number of Individuals Covered | 331 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $2,977 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
