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MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 401k Plan overview

Plan NameMOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN
Plan identification number 501

MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

MOCK BEROTH INC. has sponsored the creation of one or more 401k plans.

Company Name:MOCK BEROTH INC.
Employer identification number (EIN):582417249
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01DENISE HART2023-05-30 DENISE HART2023-05-30
5012020-12-01
5012019-12-01
5012018-12-01
5012017-12-01DENISE HART DENISE HART
5012017-12-01
5012016-12-01DENISE HART DENISE HART2018-07-10
5012015-12-01DENISE HART
5012014-12-01DENISE HART
5012013-12-01DENISE HART
5012012-12-01DENISE HART
5012011-12-01DENISE HART
5012009-12-01DENISE HART
5012008-12-01

Plan Statistics for MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN

401k plan membership statisitcs for MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN

Measure Date Value
2021: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01106
Total number of active participants reported on line 7a of the Form 55002021-12-0199
Number of retired or separated participants receiving benefits2021-12-011
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01100
2020: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01136
Total number of active participants reported on line 7a of the Form 55002020-12-01106
Number of retired or separated participants receiving benefits2020-12-011
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01107
2019: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01125
Total number of active participants reported on line 7a of the Form 55002019-12-01136
Number of retired or separated participants receiving benefits2019-12-010
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-01136
2018: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01117
Total number of active participants reported on line 7a of the Form 55002018-12-01125
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01125
2017: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-010
Total number of active participants reported on line 7a of the Form 55002017-12-010
Number of retired or separated participants receiving benefits2017-12-010
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-010
2016: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01117
Total number of active participants reported on line 7a of the Form 55002016-12-01119
Number of retired or separated participants receiving benefits2016-12-011
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-01120
2015: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01114
Total number of active participants reported on line 7a of the Form 55002015-12-01117
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-01117
2014: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01113
Total number of active participants reported on line 7a of the Form 55002014-12-01114
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-01114
2013: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01121
Total number of active participants reported on line 7a of the Form 55002013-12-01113
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-01113
2012: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01123
Total number of active participants reported on line 7a of the Form 55002012-12-01121
Number of retired or separated participants receiving benefits2012-12-010
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-01121
2011: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01155
Total number of active participants reported on line 7a of the Form 55002011-12-01123
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-01123
2009: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01160
Total number of active participants reported on line 7a of the Form 55002009-12-01156
Number of retired or separated participants receiving benefits2009-12-010
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-01156

Form 5500 Responses for MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN

2021: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2021 form 5500 responses
2021-12-01Type of plan entityMulitple employer plan
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – InsuranceYes
2020: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2020 form 5500 responses
2020-12-01Type of plan entityMulitple employer plan
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – InsuranceYes
2019: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2019 form 5500 responses
2019-12-01Type of plan entityMulitple employer plan
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – InsuranceYes
2018: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2018 form 5500 responses
2018-12-01Type of plan entityMulitple employer plan
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – InsuranceYes
2017: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2017 form 5500 responses
2017-12-01Type of plan entityMulitple employer plan
2017-12-01Submission has been amendedYes
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – InsuranceYes
2016: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2016 form 5500 responses
2016-12-01Type of plan entityMulitple employer plan
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – InsuranceYes
2015: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2015 form 5500 responses
2015-12-01Type of plan entityMulitple employer plan
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – InsuranceYes
2014: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2014 form 5500 responses
2014-12-01Type of plan entityMulitple employer plan
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – InsuranceYes
2013: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2013 form 5500 responses
2013-12-01Type of plan entityMulitple employer plan
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan benefit arrangement – InsuranceYes
2012: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2012 form 5500 responses
2012-12-01Type of plan entityMulitple employer plan
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan benefit arrangement – InsuranceYes
2011: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2011 form 5500 responses
2011-12-01Type of plan entityMulitple employer plan
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – InsuranceYes
2009: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2009 form 5500 responses
2009-12-01Type of plan entityMulitple employer plan
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – InsuranceYes
2008: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2008 form 5500 responses
2008-12-01Type of plan entityMulitple employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0922523
Policy instance 7
Insurance contract or identification number0922523
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 1
Insurance contract or identification number1049435
Number of Individuals Covered175
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $17,689
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,404
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38047
Policy instance 2
Insurance contract or identification number38047
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number082692
Policy instance 3
Insurance contract or identification number082692
Number of Individuals Covered215
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $13,428
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $715,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,428
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 4
Insurance contract or identification number35487
Number of Individuals Covered10
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $1,879
Other welfare benefits providedGAP
Welfare Benefit Premiums Paid to CarrierUSD $12,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,548
Insurance broker organization code?3
RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 )
Policy contract numberKB20A20
Policy instance 5
Insurance contract or identification numberKB20A20
Number of Individuals Covered95
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $3,918
Other welfare benefits providedHOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to CarrierUSD $21,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,577
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number038047
Policy instance 6
Insurance contract or identification number038047
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 1
Insurance contract or identification number1049435
Number of Individuals Covered172
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $15,355
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,355
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38047
Policy instance 2
Insurance contract or identification number38047
Number of Individuals Covered95
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number082692
Policy instance 3
Insurance contract or identification number082692
Number of Individuals Covered125
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 4
Insurance contract or identification number35487
Number of Individuals Covered15
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $2,092
Other welfare benefits providedGAP
Welfare Benefit Premiums Paid to CarrierUSD $13,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,802
Insurance broker organization code?3
RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 )
Policy contract numberKB20A20
Policy instance 5
Insurance contract or identification numberKB20A20
Number of Individuals Covered108
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $17,924
Other welfare benefits providedHOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to CarrierUSD $25,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,826
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number038047
Policy instance 6
Insurance contract or identification number038047
Number of Individuals Covered76
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $950
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $950
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0922523
Policy instance 7
Insurance contract or identification number0922523
Number of Individuals Covered100
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $2,500
Total amount of fees paid to insurance companyUSD $15,778
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $700,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees15778
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Commission paid to Insurance BrokerUSD $2,500
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 1
Insurance contract or identification number1049435
Number of Individuals Covered227
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $17,665
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,665
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38047
Policy instance 2
Insurance contract or identification number38047
Number of Individuals Covered95
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $989
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $989
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number082692
Policy instance 3
Insurance contract or identification number082692
Number of Individuals Covered125
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $17,223
Total amount of fees paid to insurance companyUSD $323
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $367,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,223
Amount paid for insurance broker fees323
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 4
Insurance contract or identification number35487
Number of Individuals Covered31
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $2,810
Other welfare benefits providedGAP
Welfare Benefit Premiums Paid to CarrierUSD $22,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,682
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number95125
Policy instance 7
Insurance contract or identification number95125
Number of Individuals Covered22
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $3,660
Other welfare benefits providedGAP INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $24,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,660
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number38047
Policy instance 6
Insurance contract or identification number38047
Number of Individuals Covered84
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $1,143
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,143
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number082692
Policy instance 5
Insurance contract or identification number082692
Number of Individuals Covered184
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $26,632
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $321,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,632
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 4
Insurance contract or identification number35487
Number of Individuals Covered4
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $742
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $1,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $559
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 3
Insurance contract or identification number35487
Number of Individuals Covered4
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $613
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $1,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $480
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number35487
Policy instance 2
Insurance contract or identification number35487
Number of Individuals Covered6
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $988
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $751
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 1
Insurance contract or identification number1049435
Number of Individuals Covered227
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $16,794
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,794
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 1
Insurance contract or identification number1049435
Number of Individuals Covered234
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Total amount of commissions paid to insurance brokerUSD $11,634
Total amount of fees paid to insurance companyUSD $4,415
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,193
Insurance broker nameDIGITAL INSURANCE INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4367918
Policy instance 2
Insurance contract or identification numberE4367918
Number of Individuals Covered51
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Total amount of commissions paid to insurance brokerUSD $9,163
Total amount of fees paid to insurance companyUSD $1,881
Welfare Benefit Premiums Paid to CarrierUSD $40,499
Insurance broker nameDIGITAL INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number695041
Policy instance 3
Insurance contract or identification number695041
Number of Individuals Covered186
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Welfare Benefit Premiums Paid to CarrierUSD $836,984
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1049435
Policy instance 2
Insurance contract or identification number1049435
Number of Individuals Covered235
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $9,655
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,655
Insurance broker organization code?3
Insurance broker nameDIGITAL INSURANCE INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number580663085
Policy instance 1
Insurance contract or identification number580663085
Number of Individuals Covered22
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $2,595
Total amount of fees paid to insurance companyUSD $128
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $849
Amount paid for insurance broker fees58
Additional information about fees paid to insurance brokerFEES & AWARDS
Insurance broker organization code?3
Insurance broker nameEXSEPTIONAL SERVICES, INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4367918
Policy instance 3
Insurance contract or identification numberE4367918
Number of Individuals Covered60
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $14,127
Total amount of fees paid to insurance companyUSD $4,440
Welfare Benefit Premiums Paid to CarrierUSD $22,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1
Insurance broker organization code?3
Amount paid for insurance broker fees174
Insurance broker nameDIGITAL INSURANCE INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448476
Policy instance 1
Insurance contract or identification number5448476
Number of Individuals Covered140
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $9,729
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE AND VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $86,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,150
Insurance broker organization code?3
Insurance broker nameDIGITAL INSURANCE, INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number580663085
Policy instance 3
Insurance contract or identification number580663085
Number of Individuals Covered81
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $7,227
Total amount of fees paid to insurance companyUSD $119
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,726
Amount paid for insurance broker fees62
Additional information about fees paid to insurance brokerFEES & AWARDS
Insurance broker organization code?3
Insurance broker nameEXSEPTIONAL SERVICES, INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberMBINC98
Policy instance 2
Insurance contract or identification numberMBINC98
Number of Individuals Covered149
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $35,017
Welfare Benefit Premiums Paid to CarrierUSD $233,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,345
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT CONCEPTS, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448476
Policy instance 1
Insurance contract or identification number5448476
Number of Individuals Covered135
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $10,093
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE AND VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $91,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,093
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFIT SERVICES
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number023060
Policy instance 2
Insurance contract or identification number023060
Number of Individuals Covered154
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $36,495
Welfare Benefit Premiums Paid to CarrierUSD $243,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,330
Insurance broker organization code?3
Additional information about fees paid to insurance broker3
Insurance broker nameCORPORATE BENEFIT CONCEPTS, INC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number580663085
Policy instance 3
Insurance contract or identification number580663085
Number of Individuals Covered85
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $9,096
Total amount of fees paid to insurance companyUSD $217
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,970
Amount paid for insurance broker fees99
Additional information about fees paid to insurance brokerFEES & AWARDS
Insurance broker organization code?3
Insurance broker nameGBS MARKETING
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number023060
Policy instance 2
Insurance contract or identification number023060
Number of Individuals Covered158
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $35,613
Welfare Benefit Premiums Paid to CarrierUSD $237,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448476
Policy instance 1
Insurance contract or identification number5448476
Number of Individuals Covered158
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $9,633
Dental Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE AND VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $86,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number580663085
Policy instance 3
Insurance contract or identification number580663085
Number of Individuals Covered113
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $11,445
Total amount of fees paid to insurance companyUSD $278
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448476
Policy instance 1
Insurance contract or identification number5448476
Number of Individuals Covered153
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $8,040
Total amount of fees paid to insurance companyUSD $438
Dental Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE AND VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $72,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number580663085
Policy instance 3
Insurance contract or identification number580663085
Number of Individuals Covered112
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $10,609
Total amount of fees paid to insurance companyUSD $192
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number023060
Policy instance 2
Insurance contract or identification number023060
Number of Individuals Covered121
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $32,377
Welfare Benefit Premiums Paid to CarrierUSD $215,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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