REPUBLIC BANCORP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE
401k plan membership statisitcs for REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE
| Measure | Date | Value |
|---|
| 2022: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,057 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,003 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 5 |
| Total of all active and inactive participants | 2022-01-01 | 1,008 |
| 2021: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,052 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 1,058 |
| 2020: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,108 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 1,111 |
| 2019: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,082 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,117 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 1,123 |
| 2018: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,026 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,071 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 1,082 |
| 2017: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 925 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,011 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 8 |
| Total of all active and inactive participants | 2017-01-01 | 1,019 |
| 2016: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 792 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 917 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 8 |
| Total of all active and inactive participants | 2016-01-01 | 925 |
| 2015: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 726 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 775 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 7 |
| Total of all active and inactive participants | 2015-01-01 | 782 |
| 2014: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 729 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 713 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 16 |
| Total of all active and inactive participants | 2014-01-01 | 729 |
| 2013: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 805 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 729 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 12 |
| Total of all active and inactive participants | 2013-01-01 | 741 |
| 2012: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 757 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 798 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 9 |
| Total of all active and inactive participants | 2012-07-01 | 807 |
| 2011: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 748 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 739 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 13 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 752 |
| 2010: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 749 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 736 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 748 |
| 2009: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 767 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 749 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 16 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 765 |
| Total participants | 2009-07-01 | 0 |
| 2022: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: REPUBLIC BANCORP EMPLOYEE BENEFIT PLAN HEALTH DENTAL LIFE 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | Yes |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 3 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 762 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 2 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1764 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $13,817 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,817 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 1 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 1003 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $11,880 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $773,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 11880 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 3 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 788 | | 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 $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 2 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1809 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $13,427 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,427 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 1 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 1052 | | 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 $14,088 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $833,309 | | 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 | 14088 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 3 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1898 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $12,230 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,230 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 2 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 810 | | 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 $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 1 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 1111 | | 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 $18,593 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $725,748 | | 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 | 18593 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 3 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 761 | | 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 $77 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,238 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 77 | | Additional information about fees paid to insurance broker | NON-MONETARY COMMISSION | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 2 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 1117 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $18,504 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $829,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,504 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 1 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1837 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,151 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,151 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 3 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 1047 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,555 | | Total amount of fees paid to insurance company | USD $13,247 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $830,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,555 | | Amount paid for insurance broker fees | 13247 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 2 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1795 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,238 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,238 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 1 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 888 | | 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 $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00482457 |
| Policy instance | 3 |
| Insurance contract or identification number | 00482457 | | Number of Individuals Covered | 992 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $28,853 | | Total amount of fees paid to insurance company | USD $13,686 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $626,773 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,853 | | Amount paid for insurance broker fees | 13686 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE LLC |
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| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) |
| Policy contract number | M00069 |
| Policy instance | 2 |
| Insurance contract or identification number | M00069 | | Number of Individuals Covered | 1702 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,120 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,120 | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE LLC |
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| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 700438 |
| Policy instance | 1 |
| Insurance contract or identification number | 700438 | | Number of Individuals Covered | 825 | | 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 $33 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,170 | | 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 | 33 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | MIKE SUMMERFIELD |
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