BIG ROCK SPORTS LLC has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2021 : BIG ROCK SPORTS, LLC PLAN 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-11-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-11-30 | $708,357 |
| Total income from all sources (including contributions) | 2021-11-30 | $5,818 |
| Total loss/gain on sale of assets | 2021-11-30 | $0 |
| Total of all expenses incurred | 2021-11-30 | $47,646 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-11-30 | $35,974 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-11-30 | $0 |
| Value of total assets at end of year | 2021-11-30 | $0 |
| Value of total assets at beginning of year | 2021-11-30 | $750,185 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-11-30 | $11,672 |
| Total interest from all sources | 2021-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-11-30 | No |
| Administrative expenses professional fees incurred | 2021-11-30 | $11,431 |
| Was this plan covered by a fidelity bond | 2021-11-30 | Yes |
| Value of fidelity bond cover | 2021-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-11-30 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2021-11-30 | $35,974 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-11-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-11-30 | $743,882 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-11-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-11-30 | $59,435 |
| Other income not declared elsewhere | 2021-11-30 | $5,818 |
| Administrative expenses (other) incurred | 2021-11-30 | $241 |
| Total non interest bearing cash at end of year | 2021-11-30 | $0 |
| Total non interest bearing cash at beginning of year | 2021-11-30 | $6,303 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-11-30 | No |
| Value of net income/loss | 2021-11-30 | $-41,828 |
| Value of net assets at end of year (total assets less liabilities) | 2021-11-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-11-30 | $41,828 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-11-30 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-11-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-11-30 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-11-30 | $648,922 |
| Did the plan have assets held for investment | 2021-11-30 | 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 | 2021-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-11-30 | Unqualified |
| Accountancy firm name | 2021-11-30 | PBMARES, LLP |
| Accountancy firm EIN | 2021-11-30 | 540737372 |
| 2020 : BIG ROCK SPORTS, LLC PLAN 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-11-30 | $708,357 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-11-30 | $258,471 |
| Total income from all sources (including contributions) | 2020-11-30 | $6,160,890 |
| Total loss/gain on sale of assets | 2020-11-30 | $0 |
| Total of all expenses incurred | 2020-11-30 | $6,096,447 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-11-30 | $5,813,411 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-11-30 | $6,160,890 |
| Value of total assets at end of year | 2020-11-30 | $750,185 |
| Value of total assets at beginning of year | 2020-11-30 | $235,856 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-11-30 | $283,036 |
| Total interest from all sources | 2020-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-11-30 | No |
| Administrative expenses professional fees incurred | 2020-11-30 | $22,574 |
| Was this plan covered by a fidelity bond | 2020-11-30 | Yes |
| Value of fidelity bond cover | 2020-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-11-30 | No |
| Contributions received from participants | 2020-11-30 | $1,858,117 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-11-30 | $743,882 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-11-30 | $63,743 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-11-30 | $59,435 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-11-30 | $42,597 |
| Administrative expenses (other) incurred | 2020-11-30 | $7,710 |
| Total non interest bearing cash at end of year | 2020-11-30 | $6,303 |
| Total non interest bearing cash at beginning of year | 2020-11-30 | $172,113 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-11-30 | No |
| Value of net income/loss | 2020-11-30 | $64,443 |
| Value of net assets at end of year (total assets less liabilities) | 2020-11-30 | $41,828 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-11-30 | $-22,615 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-11-30 | $1,586,050 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-11-30 | No |
| Contributions received in cash from employer | 2020-11-30 | $4,302,773 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-11-30 | $4,227,361 |
| Contract administrator fees | 2020-11-30 | $252,752 |
| Liabilities. Value of benefit claims payable at end of year | 2020-11-30 | $648,922 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-11-30 | $215,874 |
| Did the plan have assets held for investment | 2020-11-30 | 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 | 2020-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-11-30 | Unqualified |
| Accountancy firm name | 2020-11-30 | PBMARES, LLP |
| Accountancy firm EIN | 2020-11-30 | 540737372 |
| 2019 : BIG ROCK SPORTS, LLC PLAN 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-11-30 | $258,471 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-11-30 | $302,149 |
| Total income from all sources (including contributions) | 2019-11-30 | $4,310,707 |
| Total loss/gain on sale of assets | 2019-11-30 | $0 |
| Total of all expenses incurred | 2019-11-30 | $4,302,842 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-11-30 | $3,949,739 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-11-30 | $4,310,707 |
| Value of total assets at end of year | 2019-11-30 | $235,856 |
| Value of total assets at beginning of year | 2019-11-30 | $271,669 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-11-30 | $353,103 |
| Total interest from all sources | 2019-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-11-30 | No |
| Administrative expenses professional fees incurred | 2019-11-30 | $38,807 |
| Was this plan covered by a fidelity bond | 2019-11-30 | Yes |
| Value of fidelity bond cover | 2019-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-11-30 | No |
| Contributions received from participants | 2019-11-30 | $1,612,998 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-11-30 | $63,743 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-11-30 | $125,622 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-11-30 | $42,597 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-11-30 | $41,881 |
| Administrative expenses (other) incurred | 2019-11-30 | $222 |
| Total non interest bearing cash at end of year | 2019-11-30 | $172,113 |
| Total non interest bearing cash at beginning of year | 2019-11-30 | $146,047 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-11-30 | No |
| Value of net income/loss | 2019-11-30 | $7,865 |
| Value of net assets at end of year (total assets less liabilities) | 2019-11-30 | $-22,615 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-11-30 | $-30,480 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-11-30 | $1,048,428 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-11-30 | No |
| Contributions received in cash from employer | 2019-11-30 | $2,697,709 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-11-30 | $2,901,311 |
| Contract administrator fees | 2019-11-30 | $314,074 |
| Liabilities. Value of benefit claims payable at end of year | 2019-11-30 | $215,874 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-11-30 | $260,268 |
| Did the plan have assets held for investment | 2019-11-30 | 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 | 2019-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-11-30 | Unqualified |
| Accountancy firm name | 2019-11-30 | RSM US LLP |
| Accountancy firm EIN | 2019-11-30 | 420714325 |
| 2018 : BIG ROCK SPORTS, LLC PLAN 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-11-30 | $302,149 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-11-30 | $822,762 |
| Total income from all sources (including contributions) | 2018-11-30 | $4,772,396 |
| Total loss/gain on sale of assets | 2018-11-30 | $0 |
| Total of all expenses incurred | 2018-11-30 | $4,286,160 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-11-30 | $3,918,995 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-11-30 | $4,772,396 |
| Value of total assets at end of year | 2018-11-30 | $271,669 |
| Value of total assets at beginning of year | 2018-11-30 | $306,046 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-11-30 | $367,165 |
| Total interest from all sources | 2018-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-11-30 | No |
| Administrative expenses professional fees incurred | 2018-11-30 | $52,899 |
| Was this plan covered by a fidelity bond | 2018-11-30 | Yes |
| Value of fidelity bond cover | 2018-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-11-30 | No |
| Contributions received from participants | 2018-11-30 | $1,594,116 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-11-30 | $125,622 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-11-30 | $50,032 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-11-30 | $41,881 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-11-30 | $18,584 |
| Administrative expenses (other) incurred | 2018-11-30 | $2,449 |
| Total non interest bearing cash at end of year | 2018-11-30 | $146,047 |
| Total non interest bearing cash at beginning of year | 2018-11-30 | $256,014 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-11-30 | No |
| Value of net income/loss | 2018-11-30 | $486,236 |
| Value of net assets at end of year (total assets less liabilities) | 2018-11-30 | $-30,480 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-11-30 | $-516,716 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-11-30 | $1,180,760 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-11-30 | No |
| Contributions received in cash from employer | 2018-11-30 | $3,178,280 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-11-30 | $2,738,235 |
| Contract administrator fees | 2018-11-30 | $311,817 |
| Liabilities. Value of benefit claims payable at end of year | 2018-11-30 | $260,268 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-11-30 | $804,178 |
| Did the plan have assets held for investment | 2018-11-30 | 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 | 2018-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-11-30 | Unqualified |
| Accountancy firm name | 2018-11-30 | RSM US LLP |
| Accountancy firm EIN | 2018-11-30 | 420714325 |
| 2017 : BIG ROCK SPORTS, LLC PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-11-30 | $822,762 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-11-30 | $247,690 |
| Total income from all sources (including contributions) | 2017-11-30 | $5,222,100 |
| Total loss/gain on sale of assets | 2017-11-30 | $0 |
| Total of all expenses incurred | 2017-11-30 | $5,797,990 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-11-30 | $5,501,387 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-11-30 | $5,222,100 |
| Value of total assets at end of year | 2017-11-30 | $306,046 |
| Value of total assets at beginning of year | 2017-11-30 | $306,864 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-11-30 | $296,603 |
| Total interest from all sources | 2017-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-11-30 | No |
| Administrative expenses professional fees incurred | 2017-11-30 | $850 |
| Was this plan covered by a fidelity bond | 2017-11-30 | Yes |
| Value of fidelity bond cover | 2017-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-11-30 | No |
| Contributions received from participants | 2017-11-30 | $1,831,002 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-11-30 | $50,032 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-11-30 | $21,789 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-11-30 | $18,584 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-11-30 | $10,925 |
| Administrative expenses (other) incurred | 2017-11-30 | $20,181 |
| Total non interest bearing cash at end of year | 2017-11-30 | $256,014 |
| Total non interest bearing cash at beginning of year | 2017-11-30 | $285,075 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-11-30 | No |
| Value of net income/loss | 2017-11-30 | $-575,890 |
| Value of net assets at end of year (total assets less liabilities) | 2017-11-30 | $-516,716 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-11-30 | $59,174 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-11-30 | $1,334,575 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-11-30 | No |
| Contributions received in cash from employer | 2017-11-30 | $3,391,098 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-11-30 | $4,166,812 |
| Contract administrator fees | 2017-11-30 | $275,572 |
| Liabilities. Value of benefit claims payable at end of year | 2017-11-30 | $804,178 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-11-30 | $236,765 |
| Did the plan have assets held for investment | 2017-11-30 | 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 | 2017-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-11-30 | Unqualified |
| Accountancy firm name | 2017-11-30 | RSM US LLP |
| Accountancy firm EIN | 2017-11-30 | 420714325 |
| 2016 : BIG ROCK SPORTS, LLC PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-11-30 | $247,690 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-11-30 | $121,202 |
| Total income from all sources (including contributions) | 2016-11-30 | $4,960,476 |
| Total loss/gain on sale of assets | 2016-11-30 | $0 |
| Total of all expenses incurred | 2016-11-30 | $4,789,876 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-11-30 | $4,448,792 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-11-30 | $4,960,476 |
| Value of total assets at end of year | 2016-11-30 | $306,864 |
| Value of total assets at beginning of year | 2016-11-30 | $9,776 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-11-30 | $341,084 |
| Total interest from all sources | 2016-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-11-30 | No |
| Administrative expenses professional fees incurred | 2016-11-30 | $14,000 |
| Was this plan covered by a fidelity bond | 2016-11-30 | Yes |
| Value of fidelity bond cover | 2016-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-11-30 | No |
| Contributions received from participants | 2016-11-30 | $1,879,098 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-11-30 | $21,789 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-11-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-11-30 | $10,925 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-11-30 | $11,884 |
| Administrative expenses (other) incurred | 2016-11-30 | $32,699 |
| Total non interest bearing cash at end of year | 2016-11-30 | $285,075 |
| Total non interest bearing cash at beginning of year | 2016-11-30 | $9,776 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-11-30 | No |
| Value of net income/loss | 2016-11-30 | $170,600 |
| Value of net assets at end of year (total assets less liabilities) | 2016-11-30 | $59,174 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-11-30 | $-111,426 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-11-30 | $1,495,043 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-11-30 | No |
| Contributions received in cash from employer | 2016-11-30 | $3,081,378 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-11-30 | $2,953,749 |
| Contract administrator fees | 2016-11-30 | $294,385 |
| Liabilities. Value of benefit claims payable at end of year | 2016-11-30 | $236,765 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-11-30 | $109,318 |
| Did the plan have assets held for investment | 2016-11-30 | 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 | 2016-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-11-30 | Unqualified |
| Accountancy firm name | 2016-11-30 | RSM US LLP |
| Accountancy firm EIN | 2016-11-30 | 420714325 |
| 2015 : BIG ROCK SPORTS, LLC PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-11-30 | $119,123 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-11-30 | $324,715 |
| Total income from all sources (including contributions) | 2015-11-30 | $5,010,913 |
| Total of all expenses incurred | 2015-11-30 | $4,918,630 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-11-30 | $4,596,939 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-11-30 | $5,010,913 |
| Value of total assets at end of year | 2015-11-30 | $9,776 |
| Value of total assets at beginning of year | 2015-11-30 | $123,085 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-11-30 | $321,691 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-11-30 | No |
| Administrative expenses professional fees incurred | 2015-11-30 | $19,823 |
| Was this plan covered by a fidelity bond | 2015-11-30 | Yes |
| Value of fidelity bond cover | 2015-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-11-30 | No |
| Contributions received from participants | 2015-11-30 | $1,779,927 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-11-30 | $9,805 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-11-30 | $7,750 |
| Administrative expenses (other) incurred | 2015-11-30 | $1,614 |
| Total non interest bearing cash at end of year | 2015-11-30 | $9,776 |
| Total non interest bearing cash at beginning of year | 2015-11-30 | $123,085 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-11-30 | No |
| Value of net income/loss | 2015-11-30 | $92,283 |
| Value of net assets at end of year (total assets less liabilities) | 2015-11-30 | $-109,347 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-11-30 | $-201,630 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-11-30 | $1,679,009 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-11-30 | No |
| Contributions received in cash from employer | 2015-11-30 | $3,230,986 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-11-30 | $2,917,930 |
| Contract administrator fees | 2015-11-30 | $300,254 |
| Liabilities. Value of benefit claims payable at end of year | 2015-11-30 | $109,318 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-11-30 | $316,965 |
| Did the plan have assets held for investment | 2015-11-30 | 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 | 2015-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-11-30 | Unqualified |
| Accountancy firm name | 2015-11-30 | RSM US LLP |
| Accountancy firm EIN | 2015-11-30 | 420714325 |
| 2014 : BIG ROCK SPORTS, LLC PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-11-30 | $324,715 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-11-30 | $394,598 |
| Total income from all sources (including contributions) | 2014-11-30 | $4,777,994 |
| Total of all expenses incurred | 2014-11-30 | $4,938,771 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-11-30 | $4,620,547 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-11-30 | $4,777,994 |
| Value of total assets at end of year | 2014-11-30 | $123,085 |
| Value of total assets at beginning of year | 2014-11-30 | $353,745 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-11-30 | $318,224 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-11-30 | No |
| Administrative expenses professional fees incurred | 2014-11-30 | $19,022 |
| Was this plan covered by a fidelity bond | 2014-11-30 | Yes |
| Value of fidelity bond cover | 2014-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-11-30 | No |
| Contributions received from participants | 2014-11-30 | $1,707,072 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-11-30 | $84,274 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-11-30 | $7,750 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-11-30 | $11,976 |
| Administrative expenses (other) incurred | 2014-11-30 | $103,917 |
| Total non interest bearing cash at end of year | 2014-11-30 | $123,085 |
| Total non interest bearing cash at beginning of year | 2014-11-30 | $259,766 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-11-30 | No |
| Value of net income/loss | 2014-11-30 | $-160,777 |
| Value of net assets at end of year (total assets less liabilities) | 2014-11-30 | $-201,630 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-11-30 | $-40,853 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-11-30 | $1,745,863 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-11-30 | No |
| Contributions received in cash from employer | 2014-11-30 | $3,070,922 |
| Employer contributions (assets) at beginning of year | 2014-11-30 | $9,705 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-11-30 | $2,874,684 |
| Contract administrator fees | 2014-11-30 | $195,285 |
| Liabilities. Value of benefit claims payable at end of year | 2014-11-30 | $316,965 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-11-30 | $382,622 |
| Did the plan have assets held for investment | 2014-11-30 | 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 | 2014-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-11-30 | Unqualified |
| Accountancy firm name | 2014-11-30 | MCGLADREY LLP |
| Accountancy firm EIN | 2014-11-30 | 420714325 |
| 2013 : BIG ROCK SPORTS, LLC PLAN 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-11-30 | $394,598 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-11-30 | $127,842 |
| Total income from all sources (including contributions) | 2013-11-30 | $3,943,856 |
| Total loss/gain on sale of assets | 2013-11-30 | $0 |
| Total of all expenses incurred | 2013-11-30 | $4,461,328 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-11-30 | $4,160,923 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-11-30 | $3,943,856 |
| Value of total assets at end of year | 2013-11-30 | $353,745 |
| Value of total assets at beginning of year | 2013-11-30 | $604,461 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-11-30 | $300,405 |
| Total interest from all sources | 2013-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-11-30 | No |
| Administrative expenses professional fees incurred | 2013-11-30 | $18,992 |
| Was this plan covered by a fidelity bond | 2013-11-30 | Yes |
| Value of fidelity bond cover | 2013-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-11-30 | No |
| Contributions received from participants | 2013-11-30 | $1,738,503 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-11-30 | $84,274 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-11-30 | $377,891 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-11-30 | $11,976 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-11-30 | $11,542 |
| Administrative expenses (other) incurred | 2013-11-30 | $99,981 |
| Total non interest bearing cash at end of year | 2013-11-30 | $259,766 |
| Total non interest bearing cash at beginning of year | 2013-11-30 | $214,503 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-11-30 | No |
| Value of net income/loss | 2013-11-30 | $-517,472 |
| Value of net assets at end of year (total assets less liabilities) | 2013-11-30 | $-40,853 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-11-30 | $476,619 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-11-30 | $1,481,478 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-11-30 | No |
| Contributions received in cash from employer | 2013-11-30 | $2,205,353 |
| Employer contributions (assets) at end of year | 2013-11-30 | $9,705 |
| Employer contributions (assets) at beginning of year | 2013-11-30 | $12,067 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-11-30 | $2,679,445 |
| Contract administrator fees | 2013-11-30 | $181,432 |
| Liabilities. Value of benefit claims payable at end of year | 2013-11-30 | $382,622 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-11-30 | $116,300 |
| Did the plan have assets held for investment | 2013-11-30 | 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 | 2013-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-11-30 | Unqualified |
| Accountancy firm name | 2013-11-30 | MCGLADREY LLP |
| Accountancy firm EIN | 2013-11-30 | 420714325 |
| 2012 : BIG ROCK SPORTS, LLC PLAN 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-11-30 | $127,842 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-11-30 | $238,104 |
| Total income from all sources (including contributions) | 2012-11-30 | $4,279,172 |
| Total loss/gain on sale of assets | 2012-11-30 | $0 |
| Total of all expenses incurred | 2012-11-30 | $3,648,082 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-11-30 | $3,356,090 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-11-30 | $4,279,172 |
| Value of total assets at end of year | 2012-11-30 | $604,461 |
| Value of total assets at beginning of year | 2012-11-30 | $83,633 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-11-30 | $291,992 |
| Total interest from all sources | 2012-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-11-30 | No |
| Administrative expenses professional fees incurred | 2012-11-30 | $17,724 |
| Was this plan covered by a fidelity bond | 2012-11-30 | Yes |
| Value of fidelity bond cover | 2012-11-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-11-30 | No |
| Contributions received from participants | 2012-11-30 | $1,997,759 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-11-30 | $377,891 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-11-30 | $11,542 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-11-30 | $3,943 |
| Administrative expenses (other) incurred | 2012-11-30 | $97,896 |
| Total non interest bearing cash at end of year | 2012-11-30 | $214,503 |
| Total non interest bearing cash at beginning of year | 2012-11-30 | $83,633 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-11-30 | No |
| Value of net income/loss | 2012-11-30 | $631,090 |
| Value of net assets at end of year (total assets less liabilities) | 2012-11-30 | $476,619 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-11-30 | $-154,471 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-11-30 | $1,237,801 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-11-30 | No |
| Contributions received in cash from employer | 2012-11-30 | $2,281,413 |
| Employer contributions (assets) at end of year | 2012-11-30 | $12,067 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-11-30 | $2,118,289 |
| Contract administrator fees | 2012-11-30 | $176,372 |
| Liabilities. Value of benefit claims payable at end of year | 2012-11-30 | $116,300 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-11-30 | $234,161 |
| Did the plan have assets held for investment | 2012-11-30 | 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 | 2012-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-11-30 | Unqualified |
| Accountancy firm name | 2012-11-30 | MCGLADREY LLP |
| Accountancy firm EIN | 2012-11-30 | 420714325 |
| 2011 : BIG ROCK SPORTS, LLC PLAN 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-11-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-11-30 | $238,104 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-11-30 | $0 |
| Total income from all sources (including contributions) | 2011-11-30 | $3,137,220 |
| Total loss/gain on sale of assets | 2011-11-30 | $0 |
| Total of all expenses incurred | 2011-11-30 | $3,703,240 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-11-30 | $3,560,483 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-11-30 | $3,137,220 |
| Value of total assets at end of year | 2011-11-30 | $83,633 |
| Value of total assets at beginning of year | 2011-11-30 | $411,549 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-11-30 | $142,757 |
| Total interest from all sources | 2011-11-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-11-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-11-30 | No |
| Administrative expenses professional fees incurred | 2011-11-30 | $107,033 |
| Was this plan covered by a fidelity bond | 2011-11-30 | Yes |
| Value of fidelity bond cover | 2011-11-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-11-30 | No |
| Contributions received from participants | 2011-11-30 | $1,436,469 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-11-30 | $3,943 |
| Administrative expenses (other) incurred | 2011-11-30 | $1,884 |
| Total non interest bearing cash at end of year | 2011-11-30 | $83,633 |
| Total non interest bearing cash at beginning of year | 2011-11-30 | $411,549 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-11-30 | No |
| Value of net income/loss | 2011-11-30 | $-566,020 |
| Value of net assets at end of year (total assets less liabilities) | 2011-11-30 | $-154,471 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-11-30 | $411,549 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-11-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-11-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-11-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-11-30 | $1,320,659 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-11-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-11-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-11-30 | No |
| Contributions received in cash from employer | 2011-11-30 | $1,700,751 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-11-30 | $2,239,824 |
| Contract administrator fees | 2011-11-30 | $33,840 |
| Liabilities. Value of benefit claims payable at end of year | 2011-11-30 | $234,161 |
| Did the plan have assets held for investment | 2011-11-30 | 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 | 2011-11-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-11-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-11-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-11-30 | Unqualified |
| Accountancy firm name | 2011-11-30 | MCGLADREY LLP |
| Accountancy firm EIN | 2011-11-30 | 420714325 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970649 |
| Policy instance | 4 |
| Insurance contract or identification number | OK970649 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $10 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 10 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969194 |
| Policy instance | 2 |
| Insurance contract or identification number | FLX969194 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $133 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 133 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962944 |
| Policy instance | 3 |
| Insurance contract or identification number | VDT962944 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $76 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 76 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 5 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 886484G |
| Policy instance | 6 |
| Insurance contract or identification number | 886484G | | Number of Individuals Covered | 146 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,019 | | Total amount of fees paid to insurance company | USD $16 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,019 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 5015 |
| Policy instance | 7 |
| Insurance contract or identification number | 5015 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 752582 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 752582 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $100 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 100 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $78,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969194 |
| Policy instance | 2 |
| Insurance contract or identification number | FLX969194 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,466 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $123,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 1466 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 752582 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 752582 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,097 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $99,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 1097 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 5015 |
| Policy instance | 7 |
| Insurance contract or identification number | 5015 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 886484G |
| Policy instance | 6 |
| Insurance contract or identification number | 886484G | | Number of Individuals Covered | 146 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $11,207 | | Total amount of fees paid to insurance company | USD $175 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $74,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $11,207 | | Amount paid for insurance broker fees | 175 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 5 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970649 |
| Policy instance | 4 |
| Insurance contract or identification number | OK970649 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $114 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 114 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962944 |
| Policy instance | 3 |
| Insurance contract or identification number | VDT962944 | | Number of Individuals Covered | 484 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $837 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $68,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 837 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $74,195 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969194 |
| Policy instance | 2 |
| Insurance contract or identification number | FLX969194 | | Number of Individuals Covered | 524 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,535 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $96,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3535 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962944 |
| Policy instance | 3 |
| Insurance contract or identification number | VDT962944 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,701 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $54,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3701 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970649 |
| Policy instance | 4 |
| Insurance contract or identification number | OK970649 | | Number of Individuals Covered | 524 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $278 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,388 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 278 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 5 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 640 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 886484G |
| Policy instance | 6 |
| Insurance contract or identification number | 886484G | | Number of Individuals Covered | 135 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,629 | | Total amount of fees paid to insurance company | USD $700 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $64,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,629 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 700 | | Additional information about fees paid to insurance broker | BONUS PAID |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185525 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010185525 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,785 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $62,313 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 886484G |
| Policy instance | 10 |
| Insurance contract or identification number | 886484G | | Number of Individuals Covered | 179 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,946 | | Total amount of fees paid to insurance company | USD $1,922 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $32,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3338479 |
| Policy instance | 9 |
| Insurance contract or identification number | 3338479 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $625,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0306050 |
| Policy instance | 8 |
| Insurance contract or identification number | R0306050 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $49 | | Total amount of fees paid to insurance company | USD $127 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 040000100017915 |
| Policy instance | 7 |
| Insurance contract or identification number | 040000100017915 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,246 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $43,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $56,865 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185524 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010185524 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,505 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $53,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185523 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010185523 | | Number of Individuals Covered | 445 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,450 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $50,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 5 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 515 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 8876332 |
| Policy instance | 6 |
| Insurance contract or identification number | 8876332 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $979 | | Total amount of fees paid to insurance company | USD $133 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,483 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $69,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68641-7 |
| Policy instance | 2 |
| Insurance contract or identification number | 68641-7 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,086 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CRITICAL ILLNESS/ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $39,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,177 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | WRITING AGENT | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185525 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010185525 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $4,390 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $59,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 4390 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185523 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010185523 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,082 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $48,049 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 3082 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 6 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 499 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185524 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010185524 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $309 | | Total amount of fees paid to insurance company | USD $2,445 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $50,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $309 | | Amount paid for insurance broker fees | 2445 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 040000100017915 |
| Policy instance | 8 |
| Insurance contract or identification number | 040000100017915 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,754 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 2754 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0306050 |
| Policy instance | 9 |
| Insurance contract or identification number | R0306050 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $56 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $387 | | 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 | | Insurance broker organization code? | 3 |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 8876332 |
| Policy instance | 7 |
| Insurance contract or identification number | 8876332 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,237 | | Total amount of fees paid to insurance company | USD $302 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,017 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 153 | | Additional information about fees paid to insurance broker | ADDITIONAL FEES PAID |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30007344 |
| Policy instance | 1 |
| Insurance contract or identification number | 30007344 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $82,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68641-7 |
| Policy instance | 3 |
| Insurance contract or identification number | 68641-7 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,504 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CRITICAL ILLNESS/ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $33,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185525 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010185525 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,089 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $92,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185523 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010185523 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,201 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $62,738 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010185524 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010185524 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,005 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $53,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3338479 |
| Policy instance | 2 |
| Insurance contract or identification number | 3338479 | | Number of Individuals Covered | 535 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $-549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 8876332 |
| Policy instance | 8 |
| Insurance contract or identification number | 8876332 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,386 | | Total amount of fees paid to insurance company | USD $232 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $32,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 040000100017915 |
| Policy instance | 9 |
| Insurance contract or identification number | 040000100017915 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,133 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $50,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 ) |
| Policy contract number | 942594 |
| Policy instance | 7 |
| Insurance contract or identification number | 942594 | | Number of Individuals Covered | 535 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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