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MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 401k Plan overview

Plan NameMONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN
Plan identification number 502

MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MONUMENTAL SPORTS & ENTERTAINMENT has sponsored the creation of one or more 401k plans.

Company Name:MONUMENTAL SPORTS & ENTERTAINMENT
Employer identification number (EIN):541945853
NAIC Classification:711210
NAIC Description: Spectator Sports

Additional information about MONUMENTAL SPORTS & ENTERTAINMENT

Jurisdiction of Incorporation: District of Columbia Corporations Division
Incorporation Date:
Company Identification Number: L04054

More information about MONUMENTAL SPORTS & ENTERTAINMENT

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01KELLY SKOLADA2023-07-18
5022021-01-01KELLY SKOLADA2022-07-12
5022020-01-01KELLY SKOLADA2021-07-23
5022019-01-01KELLY SKOLADA2020-08-24
5022018-01-01KELLY SKOLODA2019-07-29
5022017-01-01
5022016-01-01
5022015-01-01KELLY SKOLODA
5022014-01-01KELLY SKOLODA
5022013-01-01PETER J BICHE PETER J BICHE2014-07-28
5022012-01-01KELLY SKOLODA KELLY SKOLODA2013-07-10
5022011-01-01KELLY SKOLODA KELLY SKOLODA2012-07-23

Plan Statistics for MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN

401k plan membership statisitcs for MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN

Measure Date Value
2022: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01454
Total number of active participants reported on line 7a of the Form 55002022-01-01491
Number of retired or separated participants receiving benefits2022-01-013
Number of other retired or separated participants entitled to future benefits2022-01-015
Total of all active and inactive participants2022-01-01499
Number of employers contributing to the scheme2022-01-010
2021: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01688
Total number of active participants reported on line 7a of the Form 55002021-01-01597
Number of retired or separated participants receiving benefits2021-01-0125
Number of other retired or separated participants entitled to future benefits2021-01-0161
Total of all active and inactive participants2021-01-01683
Number of employers contributing to the scheme2021-01-010
2020: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01596
Total number of active participants reported on line 7a of the Form 55002020-01-01450
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01450
Number of employers contributing to the scheme2020-01-010
2019: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01528
Total number of active participants reported on line 7a of the Form 55002019-01-01596
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01596
Number of employers contributing to the scheme2019-01-010
2018: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01505
Total number of active participants reported on line 7a of the Form 55002018-01-01528
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01528
Number of employers contributing to the scheme2018-01-010
2017: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01463
Total number of active participants reported on line 7a of the Form 55002017-01-01503
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01505
2016: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01400
Total number of active participants reported on line 7a of the Form 55002016-01-01463
Number of retired or separated participants receiving benefits2016-01-013
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01466
2015: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01400
Total number of active participants reported on line 7a of the Form 55002015-01-01400
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01403
2014: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01400
Total number of active participants reported on line 7a of the Form 55002014-01-01397
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01400
2013: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01390
Total number of active participants reported on line 7a of the Form 55002013-01-01389
Total of all active and inactive participants2013-01-01389
2012: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01386
Total number of active participants reported on line 7a of the Form 55002012-01-01390
Total of all active and inactive participants2012-01-01390
2011: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01438
Total number of active participants reported on line 7a of the Form 55002011-01-01386
Total of all active and inactive participants2011-01-01386

Form 5500 Responses for MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN

2022: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: MONUMENTAL SPORTS & ENTERTAINMENT WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )
Policy contract number181340001001
Policy instance 2
Insurance contract or identification number181340001001
Number of Individuals Covered142
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $2,207
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $22,068
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 number555811
Policy instance 1
Insurance contract or identification number555811
Number of Individuals Covered739
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $75,318
Total amount of fees paid to insurance companyUSD $27,449
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $1,148,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number26242 0002
Policy instance 3
Insurance contract or identification number26242 0002
Number of Individuals Covered12
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,842
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $12,463
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 number555811
Policy instance 1
Insurance contract or identification number555811
Number of Individuals Covered682
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $60,819
Total amount of fees paid to insurance companyUSD $11,525
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $959,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number26242 0002
Policy instance 3
Insurance contract or identification number26242 0002
Number of Individuals Covered13
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,828
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $12,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ARAG INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 34738 )
Policy contract number18134
Policy instance 2
Insurance contract or identification number18134
Number of Individuals Covered114
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,547
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $15,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 )
Policy contract number101
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number555811
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number26242 0002
Policy instance 4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number36621
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number26242 0002
Policy instance 4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number36621
Policy instance 1
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 )
Policy contract number101
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number555811
Policy instance 3
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 )
Policy contract number102
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number26242 0002
Policy instance 3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number36621
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number555811
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number29540
Policy instance 3
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number9018601
Policy instance 2
DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 )
Policy contract number179933
Policy instance 1
ADVANTICA REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number09018601
Policy instance 4
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number025666
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number025940
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number026242
Policy instance 2
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66966
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number025940
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number293548
Policy instance 3
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number025666
Policy instance 4
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number16D4
Policy instance 1
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberWSEP
Policy instance 5
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number0256660001
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number293548
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number025940
Policy instance 2
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 5
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number0256660001
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number293548
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number025940
Policy instance 2
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number16D4
Policy instance 1
ALLIED EYECARE, LLC D/B/A ADVANTICA EYECARE (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 5
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number16D4
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number025940
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number293548
Policy instance 3
DENTAQUEST MID-ATLANTIC, INC. (National Association of Insurance Commissioners NAIC id number: 52040 )
Policy contract number0256660001
Policy instance 4

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