AUGUSTA FIBERGLASS COATINGS, INC. has sponsored the creation of one or more 401k plans.
Additional information about AUGUSTA FIBERGLASS COATINGS, INC.
Submission information for form 5500 for 401k plan AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN
401k plan membership statisitcs for AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN
| Measure | Date | Value |
|---|
| 2022: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 116 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 116 |
| 2021: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 127 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 127 |
| 2020: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 131 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 131 |
| 2019: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 147 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 147 |
| 2018: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 151 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 151 |
| 2015: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 279 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 143 |
| Total of all active and inactive participants | 2015-05-01 | 143 |
| 2014: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 279 |
| Total of all active and inactive participants | 2014-05-01 | 279 |
| Total participants | 2014-05-01 | 0 |
| 2013: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 112 |
| Total of all active and inactive participants | 2013-05-01 | 112 |
| Total participants | 2013-05-01 | 0 |
| 2012: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 145 |
| Total of all active and inactive participants | 2012-05-01 | 145 |
| Total participants | 2012-05-01 | 0 |
| 2011: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 172 |
| Total of all active and inactive participants | 2011-05-01 | 172 |
| Total participants | 2011-05-01 | 172 |
| 2009: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 111 |
| Total of all active and inactive participants | 2009-05-01 | 111 |
| Total participants | 2009-05-01 | 111 |
| Measure | Date | Value |
|---|
| 2022 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $803,653 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $803,653 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $134,735 |
| Total plan assets at end of year | 2022-12-31 | $0 |
| Total plan assets at beginning of year | 2022-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $541,992 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $803,653 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $126,926 |
| 2021 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $761,461 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $761,461 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $145,546 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $458,751 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $761,461 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $157,164 |
| Total income from all sources | 2021-04-30 | $1,303,787 |
| Expenses. Total of all expenses incurred | 2021-04-30 | $1,303,787 |
| Benefits paid (including direct rollovers) | 2021-04-30 | $1,114,302 |
| Total plan assets at end of year | 2021-04-30 | $0 |
| Total plan assets at beginning of year | 2021-04-30 | $0 |
| Expenses. Other expenses not covered elsewhere | 2021-04-30 | $45,479 |
| Noncash contributions received | 2021-04-30 | $563,085 |
| Net plan assets at end of year (total assets less liabilities) | 2021-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2021-04-30 | $740,702 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-04-30 | $144,006 |
| 2020 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-04-30 | $703,849 |
| Expenses. Total of all expenses incurred | 2020-04-30 | $703,849 |
| Benefits paid (including direct rollovers) | 2020-04-30 | $144,253 |
| Total plan assets at end of year | 2020-04-30 | $0 |
| Total plan assets at beginning of year | 2020-04-30 | $0 |
| Expenses. Other expenses not covered elsewhere | 2020-04-30 | $391,446 |
| Net plan assets at end of year (total assets less liabilities) | 2020-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2020-04-30 | $703,849 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-04-30 | $168,150 |
| 2016 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2016 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-04-30 | No |
| Was this plan covered by a fidelity bond | 2016-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2016-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-04-30 | 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 | 2016-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-04-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-04-30 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-04-30 | No |
| Did the plan have assets held for investment | 2016-04-30 | 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 | 2016-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-04-30 | No |
| 2015 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2015 401k financial data |
|---|
| Value of total assets at end of year | 2015-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-04-30 | No |
| Was this plan covered by a fidelity bond | 2015-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2015-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-04-30 | 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 | 2015-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2015-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-04-30 | No |
| Did the plan have assets held for investment | 2015-04-30 | 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 | 2015-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-04-30 | No |
| 2014 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2014 401k financial data |
|---|
| Value of total assets at end of year | 2014-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-04-30 | No |
| Was this plan covered by a fidelity bond | 2014-04-30 | No |
| If this is an individual account plan, was there a blackout period | 2014-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-04-30 | 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 | 2014-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2014-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-04-30 | No |
| Did the plan have assets held for investment | 2014-04-30 | 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 | 2014-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-04-30 | No |
| 2013 : AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2013 401k financial data |
|---|
| Value of total assets at end of year | 2013-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-04-30 | No |
| Was this plan covered by a fidelity bond | 2013-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-04-30 | 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 | 2013-04-30 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-04-30 | No |
| Value of interest in common/collective trusts at end of year | 2013-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-04-30 | No |
| Did the plan have assets held for investment | 2013-04-30 | 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 | 2013-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-04-30 | No |
| 2022: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 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: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 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: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: AUGUSTA FIBERGLASS COATINGS, INC MEDICAL AND DRUG PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | Yes |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $352 | | Total amount of fees paid to insurance company | USD $182 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $352 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 182 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,916 | | Total amount of fees paid to insurance company | USD $864 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,916 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 864 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 3 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,975 | | Total amount of fees paid to insurance company | USD $971 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,195 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,975 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 971 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 2 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,772 | | Total amount of fees paid to insurance company | USD $2,623 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,706 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,772 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2623 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00487680 |
| Policy instance | 1 |
| Insurance contract or identification number | 00487680 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,721 | | Total amount of fees paid to insurance company | USD $2,899 | | Welfare Benefit Premiums Paid to Carrier | USD $65,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,721 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2899 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-85627 |
| Policy instance | 6 |
| Insurance contract or identification number | 70-85627 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $30,070 | | Health 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 $30,070 | | Additional information about fees paid to insurance broker | OTHER 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 | 00487680 |
| Policy instance | 1 |
| Insurance contract or identification number | 00487680 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,673 | | Total amount of fees paid to insurance company | USD $6,945 | | Welfare Benefit Premiums Paid to Carrier | USD $68,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6945 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $6,673 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00BD34 |
| Policy instance | 2 |
| Insurance contract or identification number | G00BD34 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,684 | | Total amount of fees paid to insurance company | USD $1,867 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,684 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1867 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GOOBD34 |
| Policy instance | 3 |
| Insurance contract or identification number | GOOBD34 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,104 | | Total amount of fees paid to insurance company | USD $782 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,104 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 782 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,872 | | Total amount of fees paid to insurance company | USD $813 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,872 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 813 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $394 | | Total amount of fees paid to insurance company | USD $169 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $394 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 169 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-85627-00 |
| Policy instance | 6 |
| Insurance contract or identification number | 70-85627-00 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $26,859 | | Health 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 $26,859 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-85627-00 |
| Policy instance | 6 |
| Insurance contract or identification number | 70-85627-00 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $26,413 | | Health 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 $26,413 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $4,854 | | Total amount of fees paid to insurance company | USD $783 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,854 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 783 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $2,114 | | Total amount of fees paid to insurance company | USD $234 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,114 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 234 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GOOBD34 |
| Policy instance | 3 |
| Insurance contract or identification number | GOOBD34 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $2,032 | | Total amount of fees paid to insurance company | USD $210 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,032 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 210 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00BD34 |
| Policy instance | 2 |
| Insurance contract or identification number | G00BD34 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of commissions paid to insurance broker | USD $440 | | Total amount of fees paid to insurance company | USD $58 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $440 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 58 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00487680 |
| Policy instance | 1 |
| Insurance contract or identification number | 00487680 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,473 | | Total amount of fees paid to insurance company | USD $4,141 | | Welfare Benefit Premiums Paid to Carrier | USD $67,238 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,783 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4141 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00487680 |
| Policy instance | 1 |
| Insurance contract or identification number | 00487680 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $10,347 | | Total amount of fees paid to insurance company | USD $4,762 | | Welfare Benefit Premiums Paid to Carrier | USD $76,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,297 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4762 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G00BD34 |
| Policy instance | 2 |
| Insurance contract or identification number | G00BD34 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $302 | | Total amount of fees paid to insurance company | USD $122 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $302 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 82 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GOOBD34 |
| Policy instance | 3 |
| Insurance contract or identification number | GOOBD34 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $1,123 | | Total amount of fees paid to insurance company | USD $465 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,123 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 303 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $1,290 | | Total amount of fees paid to insurance company | USD $508 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,290 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 348 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BD34 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BD34 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $4,275 | | Total amount of fees paid to insurance company | USD $1,646 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,275 | | Additional information about fees paid to insurance broker | AGENT OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1154 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-85627-00 |
| Policy instance | 6 |
| Insurance contract or identification number | 70-85627-00 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $49,824 | | Health 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 $49,824 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 911548 |
| Policy instance | 1 |
| Insurance contract or identification number | 911548 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $16,855 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $402,248 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,855 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00487680 |
| Policy instance | 1 |
| Insurance contract or identification number | 00487680 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $18,189 | | Total amount of fees paid to insurance company | USD $5,007 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT AND CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $152,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,189 | | Amount paid for insurance broker fees | 5007 | | Insurance broker organization code? | 3 | | Insurance broker name | ENDEAVOR INSURANCE SERVICE |
|
| BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 66-16945-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 66-16945-00 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $61,739 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,739 | | Insurance broker name | JOHN ADIAR B47/001 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-89652 |
| Policy instance | 1 |
| Insurance contract or identification number | 05-89652 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $49,463 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $49,463 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN ADAIR |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 058965200 |
| Policy instance | 1 |
| Insurance contract or identification number | 058965200 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $42,618 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $42,618 | | Insurance broker organization code? | 3 | | Insurance broker name | MELISSA SHEALY |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0742328 |
| Policy instance | 1 |
| Insurance contract or identification number | 0742328 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $29,918 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $29,918 | | Insurance broker organization code? | 3 | | Insurance broker name | THE A.I. GROUP |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0742328 |
| Policy instance | 1 |
| Insurance contract or identification number | 0742328 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $37,205 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 705726500 |
| Policy instance | 1 |
| Insurance contract or identification number | 705726500 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-05-01 | | Total amount of commissions paid to insurance broker | USD $32,289 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $32,289 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE |
|
