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AMTECK, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan NameAMTECK, LLC HEALTH & WELFARE PLAN
Plan identification number 501

AMTECK, LLC HEALTH & WELFARE 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

AMTECK, LLC has sponsored the creation of one or more 401k plans.

Company Name:AMTECK, LLC
Employer identification number (EIN):611350626
NAIC Classification:339900

Additional information about AMTECK, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2004-06-18
Company Identification Number: 0800362289
Legal Registered Office Address: 1387 E NEW CIRCLE RD STE 130

LEXINGTON
United States of America (USA)
40505

More information about AMTECK, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMTECK, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01JERI TACKETT2022-07-26
5012020-10-01JERI TACKETT2022-04-13
5012019-10-01JERI TACKETT2021-04-09
5012019-01-01JERI TACKETT2020-04-21
5012018-01-01
5012017-01-01

Plan Statistics for AMTECK, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for AMTECK, LLC HEALTH & WELFARE PLAN

Measure Date Value
2021: AMTECK, LLC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01650
Total number of active participants reported on line 7a of the Form 55002021-10-010
Total of all active and inactive participants2021-10-010
2020: AMTECK, LLC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01634
Total number of active participants reported on line 7a of the Form 55002020-10-01650
Total of all active and inactive participants2020-10-01650
2019: AMTECK, LLC HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01487
Total number of active participants reported on line 7a of the Form 55002019-10-01634
Total of all active and inactive participants2019-10-01634
Total participants, beginning-of-year2019-01-01550
Total number of active participants reported on line 7a of the Form 55002019-01-01487
Total of all active and inactive participants2019-01-01487
2018: AMTECK, LLC HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01492
Total number of active participants reported on line 7a of the Form 55002018-01-01550
Total of all active and inactive participants2018-01-01550
2017: AMTECK, LLC HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01454
Total number of active participants reported on line 7a of the Form 55002017-01-01489
Number of retired or separated participants receiving benefits2017-01-013
Total of all active and inactive participants2017-01-01492
Total participants2017-01-01492

Form 5500 Responses for AMTECK, LLC HEALTH & WELFARE PLAN

2021: AMTECK, LLC HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01This submission is the final filingYes
2021-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: AMTECK, LLC HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: AMTECK, LLC HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2019-01-01Type of plan entitySingle employer plan
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: AMTECK, LLC HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: AMTECK, LLC HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00616277
Policy instance 4
Insurance contract or identification numberG 00616277
Number of Individuals Covered622
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,539
Total amount of fees paid to insurance companyUSD $310
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $87,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,539
Amount paid for insurance broker fees310
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract numberKY2022
Policy instance 1
Insurance contract or identification numberKY2022
Number of Individuals Covered641
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $179,192
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 numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered693
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,711
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,711
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered609
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,259
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $853
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54774
Policy instance 5
Insurance contract or identification number54774
Number of Individuals Covered192
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,491
Other welfare benefits providedACCIDENT, CI, UNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $44,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,725
Insurance broker organization code?3
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number155214
Policy instance 6
Insurance contract or identification number155214
Number of Individuals Covered498
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $942
Other welfare benefits providedTELEMEDICINE
Welfare Benefit Premiums Paid to CarrierUSD $6,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $942
Insurance broker organization code?3
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number155214
Policy instance 6
Insurance contract or identification number155214
Number of Individuals Covered500
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $2,963
Other welfare benefits providedTELEMEDICINE
Welfare Benefit Premiums Paid to CarrierUSD $21,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,963
Insurance broker organization code?3
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract numberKY2022
Policy instance 1
Insurance contract or identification numberKY2022
Number of Individuals Covered681
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Welfare Benefit Premiums Paid to CarrierUSD $749,780
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 numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered723
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $16,482
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,486
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered652
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $5,799
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,799
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00616277
Policy instance 4
Insurance contract or identification numberG 00616277
Number of Individuals Covered650
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $36,062
Total amount of fees paid to insurance companyUSD $13,380
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $362,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,442
Amount paid for insurance broker fees12803
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54774
Policy instance 5
Insurance contract or identification number54774
Number of Individuals Covered142
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $72,508
Other welfare benefits providedACCIDENT, CANCER,CI, UNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $214,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,405
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered637
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $6,241
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,241
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00616277
Policy instance 4
Insurance contract or identification numberG 00616277
Number of Individuals Covered634
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $31,870
Total amount of fees paid to insurance companyUSD $10,283
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $337,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,870
Amount paid for insurance broker fees10283
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54774
Policy instance 5
Insurance contract or identification number54774
Number of Individuals Covered174
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $37,987
Other welfare benefits providedACCIDENT, CANCER,UNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $170,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,235
Insurance broker organization code?3
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number155214
Policy instance 6
Insurance contract or identification number155214
Number of Individuals Covered563
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $4,095
Other welfare benefits providedTELEMEDICINE
Welfare Benefit Premiums Paid to CarrierUSD $28,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,095
Insurance broker organization code?3
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered718
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $24,880
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,880
Insurance broker organization code?3
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract numberKY2022
Policy instance 1
Insurance contract or identification numberKY2022
Number of Individuals Covered703
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Welfare Benefit Premiums Paid to CarrierUSD $759,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number155214
Policy instance 6
Insurance contract or identification number155214
Number of Individuals Covered61
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $318
Other welfare benefits providedTELEMEDICINE
Welfare Benefit Premiums Paid to CarrierUSD $30,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $318
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54774
Policy instance 5
Insurance contract or identification number54774
Number of Individuals Covered343
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $27,618
Other welfare benefits providedACCIDENT, CANCER, UNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $157,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,162
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00616277
Policy instance 4
Insurance contract or identification numberG 00616277
Number of Individuals Covered673
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $29,483
Total amount of fees paid to insurance companyUSD $4,445
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $306,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,562
Amount paid for insurance broker fees4052
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered743
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $4,707
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,394
Insurance broker organization code?3
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered785
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $22,769
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,769
Insurance broker organization code?3
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract numberKY2022
Policy instance 1
Insurance contract or identification numberKY2022
Number of Individuals Covered797
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Welfare Benefit Premiums Paid to CarrierUSD $649,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number734809
Policy instance 1
Insurance contract or identification number734809
Number of Individuals Covered340
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $91,372
Total amount of fees paid to insurance companyUSD $5,042
Welfare Benefit Premiums Paid to CarrierUSD $756,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91,310
Amount paid for insurance broker fees5042
Insurance broker organization code?3
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered562
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $17,022
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,022
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered523
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $5,553
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,553
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG 00616277
Policy instance 4
Insurance contract or identification numberG 00616277
Number of Individuals Covered550
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $24,587
Total amount of fees paid to insurance companyUSD $16,969
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $251,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,587
Amount paid for insurance broker fees16969
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number54774
Policy instance 5
Insurance contract or identification number54774
Number of Individuals Covered300
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $39,148
Other welfare benefits providedACCIDENT, CANCER, UNIVERSAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $80,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,060
Insurance broker organization code?3
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number155214
Policy instance 6
Insurance contract or identification number155214
Number of Individuals Covered495
Insurance policy start date2017-04-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $872
Other welfare benefits providedTELEMEDICINE
Welfare Benefit Premiums Paid to CarrierUSD $18,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $872
Insurance broker organization code?3
Insurance broker nameEPIC INSURANCE SOLUTIONS LLC
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0011168990
Policy instance 5
Insurance contract or identification number0011168990
Number of Individuals Covered355
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $64,632
Total amount of fees paid to insurance companyUSD $12,853
Other welfare benefits providedISTDPROTEC, WHOLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $114,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,471
Amount paid for insurance broker fees10563
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number304740
Policy instance 4
Insurance contract or identification number304740
Number of Individuals Covered489
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $5,730
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $122,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,129
Insurance broker organization code?3
Insurance broker nameEPIC INSURANCE SOLUTIONS LLC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10076771001
Policy instance 3
Insurance contract or identification number10076771001
Number of Individuals Covered439
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $2,537
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,537
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK INC
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract numberDU7691
Policy instance 2
Insurance contract or identification numberDU7691
Number of Individuals Covered524
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $2,327
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,609
Insurance broker organization code?3
Insurance broker nameEPIC INSURANCE SOLUTIONS LLC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number734809
Policy instance 1
Insurance contract or identification number734809
Number of Individuals Covered330
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $132,073
Total amount of fees paid to insurance companyUSD $12,400
Welfare Benefit Premiums Paid to CarrierUSD $819,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $111,544
Insurance broker organization code?3
Amount paid for insurance broker fees12400
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameWILLLIS INS SERVICES OF GA INC

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