SOLTESZ, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM
401k plan membership statisitcs for SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM
| Measure | Date | Value |
|---|
| 2022: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 98 |
| Total of all active and inactive participants | 2022-01-01 | 98 |
| 2021: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 98 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 88 |
| Total of all active and inactive participants | 2021-01-01 | 88 |
| 2020: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 96 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 98 |
| Total of all active and inactive participants | 2020-01-01 | 98 |
| 2019: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 96 |
| Total of all active and inactive participants | 2019-01-01 | 96 |
| 2018: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 99 |
| Total of all active and inactive participants | 2018-01-01 | 99 |
| Total participants | 2018-01-01 | 99 |
| 2017: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 97 |
| Total of all active and inactive participants | 2017-01-01 | 97 |
| Total participants | 2017-01-01 | 97 |
| 2016: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 84 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 88 |
| Total of all active and inactive participants | 2016-01-01 | 88 |
| Total participants | 2016-01-01 | 88 |
| 2015: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 84 |
| Total of all active and inactive participants | 2015-01-01 | 84 |
| Total participants | 2015-01-01 | 84 |
| 2014: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 79 |
| Total of all active and inactive participants | 2014-01-01 | 79 |
| Total participants | 2014-01-01 | 79 |
| 2013: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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 | 105 |
| Total of all active and inactive participants | 2013-01-01 | 105 |
| Total participants | 2013-01-01 | 105 |
| 2012: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 94 |
| 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 |
| Total participants | 2012-01-01 | 105 |
| 2009: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 109 |
| Total of all active and inactive participants | 2009-01-01 | 109 |
| Total participants | 2009-01-01 | 109 |
| 2022: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 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: SOLTESZ, INC. FLEXIBLE COMPENSATION PROGRAM 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 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 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10151001001 |
| Policy instance | 6 |
| Insurance contract or identification number | 10151001001 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $63 | | Total amount of fees paid to insurance company | USD $5 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63 | | Amount paid for insurance broker fees | 5 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10144421001 |
| Policy instance | 5 |
| Insurance contract or identification number | 10144421001 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,711 | | Total amount of fees paid to insurance company | USD $772 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,711 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,711 | | Amount paid for insurance broker fees | 772 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259002 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010259002 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,766 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $66,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,766 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00555545 |
| Policy instance | 3 |
| Insurance contract or identification number | 00555545 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,365 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT,VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $14,871 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,365 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00196567 |
| Policy instance | 2 |
| Insurance contract or identification number | 00196567 | | Number of Individuals Covered | 98 | | 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 $17,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 17580 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND SERVICE FEES |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 98 | | 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 $99,669 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $196,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 65295 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 88 | | 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 $101,763 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $201,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 66220 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00196567 |
| Policy instance | 2 |
| Insurance contract or identification number | 00196567 | | Number of Individuals Covered | 88 | | 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 $16,681 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16681 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND SERVICE FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00555545 |
| Policy instance | 3 |
| Insurance contract or identification number | 00555545 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,682 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT,VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $18,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,682 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259002 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010259002 | | 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 $6,706 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $65,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,616 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10144421001 |
| Policy instance | 5 |
| Insurance contract or identification number | 10144421001 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,772 | | Total amount of fees paid to insurance company | USD $847 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,772 | | Amount paid for insurance broker fees | 847 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 98 | | 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 $112,808 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $212,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 75268 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00196567 |
| Policy instance | 2 |
| Insurance contract or identification number | 00196567 | | Number of Individuals Covered | 98 | | 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 $17,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 17326 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND SERVICE FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00555545 |
| Policy instance | 3 |
| Insurance contract or identification number | 00555545 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,333 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT,VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $18,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,333 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259002 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010259002 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,554 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $79,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,554 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10144421001 |
| Policy instance | 5 |
| Insurance contract or identification number | 10144421001 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,949 | | Total amount of fees paid to insurance company | USD $564 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,949 | | Amount paid for insurance broker fees | 564 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00196567 |
| Policy instance | 3 |
| Insurance contract or identification number | 00196567 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2019-01-01 | | 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 $17,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 17289 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND SERVICE FEES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B9B9 |
| Policy instance | 2 |
| Insurance contract or identification number | G000B9B9 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,669 | | Total amount of fees paid to insurance company | USD $2,602 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $73,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,669 | | Amount paid for insurance broker fees | 2602 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 96 | | Insurance policy start date | 2019-01-01 | | 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 $109,525 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $196,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 74849 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00196567 |
| Policy instance | 4 |
| Insurance contract or identification number | 00196567 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $17,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 17828 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND SERVICE FEES | | Insurance broker name | CIGNA HEALTH AND LIFE INSURANCE |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008708222 |
| Policy instance | 3 |
| Insurance contract or identification number | 0008708222 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-10-01 | | Total amount of commissions paid to insurance broker | USD $49 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BROCKMAN, WILLIAM, HENRY |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 97 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $121,769 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $209,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 84848 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | CBIZ |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010180332 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010180332 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,452 | | Total amount of fees paid to insurance company | USD $339 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $72,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,452 | | Amount paid for insurance broker fees | 339 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
|
| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 84 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $61,708 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $174,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 40725 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | CBIZ |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010180332 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010180332 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $5,760 | | Total amount of fees paid to insurance company | USD $154 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $54,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,760 | | Amount paid for insurance broker fees | 154 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3628070 |
| Policy instance | 3 |
| Insurance contract or identification number | E3628070 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $4,299 | | Total amount of fees paid to insurance company | USD $506 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,721 | | Amount paid for insurance broker fees | 406 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | TRACEY HAMILTON |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008708222 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008708222 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-10-01 | | Total amount of commissions paid to insurance broker | USD $71 | | Total amount of fees paid to insurance company | USD $31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker name | CUSTOM BENEFIT PROGRAMS INC |
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| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 1 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 79 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $63,259 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $172,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 41068 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | CBIZ |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010180332 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010180332 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $7,531 | | Total amount of fees paid to insurance company | USD $3,069 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $68,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,531 | | Amount paid for insurance broker fees | 3069 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3628070 |
| Policy instance | 3 |
| Insurance contract or identification number | E3628070 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $7,399 | | Total amount of fees paid to insurance company | USD $1,281 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,793 | | Amount paid for insurance broker fees | 1094 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MICHELLE ELAINE HILL |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008708222 |
| Policy instance | 4 |
| Insurance contract or identification number | 0008708222 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $69 | | Total amount of fees paid to insurance company | USD $41 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker name | CUSTOM BENEFIT PROGRAMS INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010180332 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010180332 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2013-10-31 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,002 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,002 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3628070 |
| Policy instance | 5 |
| Insurance contract or identification number | E3628070 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $5,936 | | Total amount of fees paid to insurance company | USD $300 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,183 | | Amount paid for insurance broker fees | 207 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DURWOOD BOOTH JR |
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| THE LOOMIS COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | FSOLT |
| Policy instance | 3 |
| Insurance contract or identification number | FSOLT | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,815 | | Total amount of fees paid to insurance company | USD $10,623 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7176 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $4,815 | | Insurance broker name | CBIZ |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0297960 |
| Policy instance | 2 |
| Insurance contract or identification number | R0297960 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of fees paid to insurance company | USD $8,688 | | Are there contracts with allocated funds for individual policies? | Yes | | Contracts With Unallocated Funds Deposit Administration | 1 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $65,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 8688 | | Additional information about fees paid to insurance broker | SALES AND SERVICE COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
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| STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
| Policy contract number | SSLIHCRD0024812 |
| Policy instance | 1 |
| Insurance contract or identification number | SSLIHCRD0024812 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,336 | | Total amount of fees paid to insurance company | USD $51,441 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $133,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,336 | | Amount paid for insurance broker fees | 51441 | | Additional information about fees paid to insurance broker | SERVICE COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | BROKERAGE CONCEPTS, INC. |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0297960 |
| Policy instance | 2 |
| Insurance contract or identification number | R0297960 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $4,892 | | Total amount of fees paid to insurance company | USD $3,560 | | Are there contracts with allocated funds for individual policies? | Yes | | Contracts With Unallocated Funds Deposit Administration | 1 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $67,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,892 | | Amount paid for insurance broker fees | 701 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INSURANCE SERVICES |
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| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | N/A |
| Policy instance | 1 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 105 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,515 | | Total amount of fees paid to insurance company | USD $56,275 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $176,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,515 | | Amount paid for insurance broker fees | 56275 | | Insurance broker organization code? | 3 | | Insurance broker name | BROKERAGE CONCEPTS, INC. |
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