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ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 401k Plan overview

Plan NameROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN
Plan identification number 501

ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

ROGER BOUCHARD INSURANCE, INC. has sponsored the creation of one or more 401k plans.

Company Name:ROGER BOUCHARD INSURANCE, INC.
Employer identification number (EIN):591117778
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Additional information about ROGER BOUCHARD INSURANCE, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1966-04-11
Company Identification Number: 304036
Legal Registered Office Address: 101 STARCREST DRIVE

CLEARWATER

33765

More information about ROGER BOUCHARD INSURANCE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-01-01MATT ELSEY2019-07-29
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01MATT ELSEY
5012013-01-01MATT ELSEY
5012012-01-01MATT ELSEY
5012011-01-01MATT ELSEY
5012009-01-01DELORES MOORE

Plan Statistics for ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN

401k plan membership statisitcs for ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN

Measure Date Value
2018: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01252
Total number of active participants reported on line 7a of the Form 55002018-01-01254
Number of retired or separated participants receiving benefits2018-01-0110
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01264
2017: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01229
Total number of active participants reported on line 7a of the Form 55002017-01-01234
Number of retired or separated participants receiving benefits2017-01-0112
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-01252
2016: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01239
Total number of active participants reported on line 7a of the Form 55002016-01-01209
Number of retired or separated participants receiving benefits2016-01-0112
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-01224
2015: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01202
Total number of active participants reported on line 7a of the Form 55002015-01-01222
Number of retired or separated participants receiving benefits2015-01-019
Number of other retired or separated participants entitled to future benefits2015-01-018
Total of all active and inactive participants2015-01-01239
2014: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01197
Total number of active participants reported on line 7a of the Form 55002014-01-01199
Number of retired or separated participants receiving benefits2014-01-0111
Number of other retired or separated participants entitled to future benefits2014-01-0110
Total of all active and inactive participants2014-01-01220
2013: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01191
Total number of active participants reported on line 7a of the Form 55002013-01-01194
Number of retired or separated participants receiving benefits2013-01-0114
Number of other retired or separated participants entitled to future benefits2013-01-0112
Total of all active and inactive participants2013-01-01220
2012: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01210
Total number of active participants reported on line 7a of the Form 55002012-01-01185
Number of retired or separated participants receiving benefits2012-01-019
Number of other retired or separated participants entitled to future benefits2012-01-012
Total of all active and inactive participants2012-01-01196
2011: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01184
Total number of active participants reported on line 7a of the Form 55002011-01-01185
Number of retired or separated participants receiving benefits2011-01-016
Number of other retired or separated participants entitled to future benefits2011-01-019
Total of all active and inactive participants2011-01-01200
2009: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01190
Total number of active participants reported on line 7a of the Form 55002009-01-01185
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-015
Total of all active and inactive participants2009-01-01192
Total participants2009-01-01192

Form 5500 Responses for ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN

2018: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: ROGER BOUCHARD INSURANCE INC GROUP MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0608394
Policy instance 1
Insurance contract or identification number0608394
Number of Individuals Covered169
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $98,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number34499
Policy instance 2
Insurance contract or identification number34499
Number of Individuals Covered217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,391
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 numberSGD603639
Policy instance 3
Insurance contract or identification numberSGD603639
Number of Individuals Covered234
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,566
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $35,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,566
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameROGER BOUCHARD INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM603693
Policy instance 4
Insurance contract or identification numberSGM603693
Number of Individuals Covered234
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,944
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $79,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,944
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameROGER BOUCHARD INSURANCE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK602670
Policy instance 5
Insurance contract or identification numberSOK602670
Number of Individuals Covered234
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,151
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&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 CarrierUSD $7,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,151
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameROGER BOUCHARD INSURANCE
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7255086
Policy instance 6
Insurance contract or identification numberE7255086
Number of Individuals Covered77
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,632
Total amount of fees paid to insurance companyUSD $1,929
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedWORKSITE BENEFITS
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 CarrierUSD $61,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,687
Amount paid for insurance broker fees514
Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
Insurance broker organization code?3
Insurance broker nameDUPUY & ASSOCIATES INC

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