PIEDMONT PLASTIC SURGERY AND DERM. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE
401k plan membership statisitcs for PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE
| Measure | Date | Value |
|---|
| 2022: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 271 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 263 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
| Total of all active and inactive participants | 2022-08-01 | 263 |
| 2021: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 232 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 271 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
| Total of all active and inactive participants | 2021-08-01 | 271 |
| 2020: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 232 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
| Total of all active and inactive participants | 2020-08-01 | 232 |
| 2019: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 209 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
| Total of all active and inactive participants | 2019-08-01 | 209 |
| 2018: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 201 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
| Total of all active and inactive participants | 2018-08-01 | 201 |
| 2017: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 151 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
| Total of all active and inactive participants | 2017-08-01 | 151 |
| 2016: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 176 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
| Total of all active and inactive participants | 2016-08-01 | 176 |
| 2015: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 173 |
| Total of all active and inactive participants | 2015-08-01 | 173 |
| Measure | Date | Value |
|---|
| 2023 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2023 401k financial data |
|---|
| Total income from all sources (including contributions) | 2023-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-07-31 | No |
| Was this plan covered by a fidelity bond | 2023-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2023-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2023-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-07-31 | No |
| Did the plan have assets held for investment | 2023-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-07-31 | No |
| 2022 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-07-31 | No |
| Was this plan covered by a fidelity bond | 2022-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2022-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-07-31 | No |
| Did the plan have assets held for investment | 2022-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-07-31 | No |
| 2021 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-07-31 | No |
| Was this plan covered by a fidelity bond | 2021-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2021-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-07-31 | No |
| Did the plan have assets held for investment | 2021-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-07-31 | No |
| 2020 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-07-31 | No |
| Was this plan covered by a fidelity bond | 2020-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2020-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-07-31 | No |
| Did the plan have assets held for investment | 2020-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-07-31 | No |
| 2019 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-07-31 | No |
| Was this plan covered by a fidelity bond | 2019-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2019-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-07-31 | No |
| Did the plan have assets held for investment | 2019-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-07-31 | No |
| 2018 : PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-07-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-07-31 | No |
| Was this plan covered by a fidelity bond | 2018-07-31 | No |
| If this is an individual account plan, was there a blackout period | 2018-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-07-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-07-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2018-07-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-07-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-07-31 | No |
| Did the plan have assets held for investment | 2018-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-07-31 | No |
| 2022: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PIEDMONT PLASTIC SURGERY & DERMATOLOGY EMPLOYEE BE 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | First time form 5500 has been submitted | Yes |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRODIGY HEALTH INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 52421 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 263 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Total amount of fees paid to insurance company | USD $148,968 | | Welfare Benefit Premiums Paid to Carrier | USD $480,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 88017 | | Additional information about fees paid to insurance broker | BENEFIT ADMINISTRATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $27,500 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 139009 |
| Policy instance | 4 |
| Insurance contract or identification number | 139009 | | Number of Individuals Covered | 341 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $21,385 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,385 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1D039902 |
| Policy instance | 3 |
| Insurance contract or identification number | 1D039902 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $14,729 | | Total amount of fees paid to insurance company | USD $4,419 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $147,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,288 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4419 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $6,037 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,252 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,650 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $1,948 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,178 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $2,022 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,229 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $6,290 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,822 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1D039902 |
| Policy instance | 3 |
| Insurance contract or identification number | 1D039902 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $17,825 | | Total amount of fees paid to insurance company | USD $5,347 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,825 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5347 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 139009 |
| Policy instance | 4 |
| Insurance contract or identification number | 139009 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $17,336 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,336 | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 271 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Total amount of fees paid to insurance company | USD $143,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 86505 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $30,000 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 232 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Total amount of fees paid to insurance company | USD $126,715 | | Welfare Benefit Premiums Paid to Carrier | USD $435,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 74285 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $30,000 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 139009 |
| Policy instance | 4 |
| Insurance contract or identification number | 139009 | | Number of Individuals Covered | 316 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $15,809 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,809 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1D039902 |
| Policy instance | 3 |
| Insurance contract or identification number | 1D039902 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $13,610 | | Total amount of fees paid to insurance company | USD $4,083 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $136,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,610 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4083 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $6,303 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,023 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,202 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,032 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,355 | | Insurance broker organization code? | 3 |
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 756776 |
| Policy instance | 4 |
| Insurance contract or identification number | 756776 | | Number of Individuals Covered | 288 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $14,151 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,151 | | Insurance broker organization code? | 3 |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1D039902 |
| Policy instance | 3 |
| Insurance contract or identification number | 1D039902 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $14,640 | | Total amount of fees paid to insurance company | USD $4,392 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $146,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,640 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4392 |
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| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $5,088 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,392 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $1,641 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,943 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,094 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $1,686 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $562 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $5,232 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,488 | | Insurance broker organization code? | 3 |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5938589 |
| Policy instance | 3 |
| Insurance contract or identification number | 5938589 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $1,301 | | Total amount of fees paid to insurance company | USD $55 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $-164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,001 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 55 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION |
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 756776 |
| Policy instance | 4 |
| Insurance contract or identification number | 756776 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $22,021 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,681 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 2 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $4,968 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 1 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $1,599 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 406 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $13,613 | | Total amount of fees paid to insurance company | USD $80 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50005481 |
| Policy instance | 5 |
| Insurance contract or identification number | 50005481 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $5,197 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,393 | | Insurance broker name | MARK E. MCINTOSH |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F1D0955 |
| Policy instance | 4 |
| Insurance contract or identification number | F1D0955 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $697 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $558 | | Insurance broker name | BENEUSA, LLC |
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| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 173 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $27,000 | | Total amount of fees paid to insurance company | USD $50,245 | | Welfare Benefit Premiums Paid to Carrier | USD $185,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,000 | | Amount paid for insurance broker fees | 50245 | | Insurance broker organization code? | 3 | | Insurance broker name | MARK MCINTOSH |
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