ACADIANA BOTTLING COMPANY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN
401k plan membership statisitcs for ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2023 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2023 401k financial data |
|---|
| Total income from all sources (including contributions) | 2023-04-30 | $646,650 |
| Total of all expenses incurred | 2023-04-30 | $646,650 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-04-30 | $563,049 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-04-30 | $646,650 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-04-30 | $83,601 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-04-30 | No |
| Was this plan covered by a fidelity bond | 2023-04-30 | Yes |
| Value of fidelity bond cover | 2023-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-04-30 | No |
| Contributions received from participants | 2023-04-30 | $306,119 |
| Administrative expenses (other) incurred | 2023-04-30 | $35,928 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-04-30 | No |
| Value of net income/loss | 2023-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-04-30 | $204,368 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-04-30 | No |
| Contributions received in cash from employer | 2023-04-30 | $340,531 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-04-30 | $358,681 |
| Contract administrator fees | 2023-04-30 | $47,673 |
| Did the plan have assets held for investment | 2023-04-30 | 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 | 2023-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-04-30 | Yes |
| 2022 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-04-30 | $731,629 |
| Total of all expenses incurred | 2022-04-30 | $731,629 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-04-30 | $651,591 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-04-30 | $731,629 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-04-30 | $80,038 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-04-30 | No |
| Was this plan covered by a fidelity bond | 2022-04-30 | Yes |
| Value of fidelity bond cover | 2022-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-04-30 | No |
| Contributions received from participants | 2022-04-30 | $323,954 |
| Administrative expenses (other) incurred | 2022-04-30 | $34,186 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-04-30 | No |
| Value of net income/loss | 2022-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-04-30 | $214,069 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-04-30 | No |
| Contributions received in cash from employer | 2022-04-30 | $407,675 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-04-30 | $437,522 |
| Contract administrator fees | 2022-04-30 | $45,852 |
| Did the plan have assets held for investment | 2022-04-30 | 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 | 2022-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-04-30 | Yes |
| 2020 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-04-30 | $1,109,264 |
| Total of all expenses incurred | 2020-04-30 | $1,109,264 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-04-30 | $1,031,389 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-04-30 | $1,109,264 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-04-30 | $77,875 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-04-30 | No |
| Was this plan covered by a fidelity bond | 2020-04-30 | Yes |
| Value of fidelity bond cover | 2020-04-30 | $400,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-04-30 | No |
| Contributions received from participants | 2020-04-30 | $361,670 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-04-30 | $82,027 |
| Administrative expenses (other) incurred | 2020-04-30 | $32,592 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
| Value of net income/loss | 2020-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-04-30 | $263,120 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-04-30 | No |
| Contributions received in cash from employer | 2020-04-30 | $665,567 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-04-30 | $768,269 |
| Contract administrator fees | 2020-04-30 | $45,283 |
| Did the plan have assets held for investment | 2020-04-30 | 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 | 2020-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-04-30 | Yes |
| 2019 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-04-30 | $899,122 |
| Total of all expenses incurred | 2019-04-30 | $899,122 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-04-30 | $817,161 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-04-30 | $899,122 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-04-30 | $81,961 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-04-30 | No |
| Was this plan covered by a fidelity bond | 2019-04-30 | Yes |
| Value of fidelity bond cover | 2019-04-30 | $4,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-04-30 | No |
| Contributions received from participants | 2019-04-30 | $344,545 |
| Administrative expenses (other) incurred | 2019-04-30 | $37,369 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
| Value of net income/loss | 2019-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-04-30 | $249,808 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-04-30 | No |
| Contributions received in cash from employer | 2019-04-30 | $554,577 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-04-30 | $567,353 |
| Contract administrator fees | 2019-04-30 | $44,592 |
| Did the plan have assets held for investment | 2019-04-30 | 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 | 2019-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-04-30 | Yes |
| 2018 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-04-30 | $911,101 |
| Total of all expenses incurred | 2018-04-30 | $911,101 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-04-30 | $853,062 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-04-30 | $911,101 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-04-30 | $58,039 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-04-30 | No |
| Was this plan covered by a fidelity bond | 2018-04-30 | Yes |
| Value of fidelity bond cover | 2018-04-30 | $400,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-04-30 | No |
| Contributions received from participants | 2018-04-30 | $344,545 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-04-30 | $3,389 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-04-30 | $22,911 |
| Administrative expenses (other) incurred | 2018-04-30 | $11,114 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
| Value of net income/loss | 2018-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-04-30 | $317,799 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-04-30 | No |
| Contributions received in cash from employer | 2018-04-30 | $563,167 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-04-30 | $512,352 |
| Contract administrator fees | 2018-04-30 | $46,925 |
| Did the plan have assets held for investment | 2018-04-30 | 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 | 2018-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-04-30 | Yes |
| 2016 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-04-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-04-30 | $0 |
| Total income from all sources (including contributions) | 2016-04-30 | $1,288,551 |
| Total of all expenses incurred | 2016-04-30 | $1,288,551 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-04-30 | $1,228,524 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-04-30 | $1,288,551 |
| Value of total assets at end of year | 2016-04-30 | $0 |
| Value of total assets at beginning of year | 2016-04-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-04-30 | $60,027 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-04-30 | No |
| Assets. Real estate other than employer real property at end of year | 2016-04-30 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2016-04-30 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2016-04-30 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2016-04-30 | $0 |
| Was this plan covered by a fidelity bond | 2016-04-30 | Yes |
| Value of fidelity bond cover | 2016-04-30 | $4,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-04-30 | No |
| Contributions received from participants | 2016-04-30 | $296,280 |
| Participant contributions at end of year | 2016-04-30 | $0 |
| Participant contributions at beginning of year | 2016-04-30 | $0 |
| Participant contributions at end of year | 2016-04-30 | $0 |
| Participant contributions at beginning of year | 2016-04-30 | $0 |
| Assets. Other investments not covered elsewhere at end of year | 2016-04-30 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2016-04-30 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-04-30 | $173,810 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-04-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-04-30 | $0 |
| Assets. Loans (other than to participants) at end of year | 2016-04-30 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2016-04-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-04-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-04-30 | $0 |
| Liabilities. Value of operating payables at end of year | 2016-04-30 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2016-04-30 | $0 |
| Total non interest bearing cash at end of year | 2016-04-30 | $0 |
| Total non interest bearing cash at beginning of year | 2016-04-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-04-30 | No |
| Value of net income/loss | 2016-04-30 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2016-04-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-04-30 | No |
| Assets. partnership/joint venture interests at end of year | 2016-04-30 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2016-04-30 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-04-30 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-04-30 | $0 |
| Value of interest in pooled separate accounts at end of year | 2016-04-30 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2016-04-30 | $0 |
| Value of interest in master investment trust accounts at end of year | 2016-04-30 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2016-04-30 | $0 |
| Value of interest in common/collective trusts at end of year | 2016-04-30 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2016-04-30 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-04-30 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-04-30 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-04-30 | $0 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2016-04-30 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2016-04-30 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2016-04-30 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2016-04-30 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-04-30 | $276,213 |
| Asset value of US Government securities at end of year | 2016-04-30 | $0 |
| Asset value of US Government securities at beginning of year | 2016-04-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-04-30 | No |
| Assets. Invements in employer securities at end of year | 2016-04-30 | $0 |
| Assets. Invements in employer securities at beginning of year | 2016-04-30 | $0 |
| Assets. Value of employer real property at end of year | 2016-04-30 | $0 |
| Assets. Value of employer real property at beginning of year | 2016-04-30 | $0 |
| Contributions received in cash from employer | 2016-04-30 | $818,461 |
| Employer contributions (assets) at end of year | 2016-04-30 | $0 |
| Employer contributions (assets) at beginning of year | 2016-04-30 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-04-30 | $952,311 |
| Asset. Corporate debt instrument preferred debt at end of year | 2016-04-30 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2016-04-30 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2016-04-30 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2016-04-30 | $0 |
| Contract administrator fees | 2016-04-30 | $60,027 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2016-04-30 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2016-04-30 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2016-04-30 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-04-30 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-04-30 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-04-30 | $0 |
| Did the plan have assets held for investment | 2016-04-30 | 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 | 2016-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-04-30 | Yes |
| Liabilities. Value of acquisition indebtedness at end of year | 2016-04-30 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2016-04-30 | $0 |
| 2012 : ACADIANA BOTTLING CO INC HEALTH BENEFITS PLAN 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-04-30 | $1,282,435 |
| Total of all expenses incurred | 2012-04-30 | $1,282,435 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-04-30 | $1,230,770 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-04-30 | $1,282,435 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-04-30 | $51,665 |
| Was this plan covered by a fidelity bond | 2012-04-30 | Yes |
| Value of fidelity bond cover | 2012-04-30 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-04-30 | No |
| Contributions received from participants | 2012-04-30 | $261,797 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-04-30 | $30,773 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
| Value of net income/loss | 2012-04-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-04-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-04-30 | $380,492 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-04-30 | No |
| Contributions received in cash from employer | 2012-04-30 | $989,865 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-04-30 | $850,278 |
| Contract administrator fees | 2012-04-30 | $51,665 |
| Did the plan have assets held for investment | 2012-04-30 | 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 | 2012-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-04-30 | Yes |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $204,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $214,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ASF4 |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0ASF4 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $4,977 | | Total amount of fees paid to insurance company | USD $1,919 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $38,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,977 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1919 | | Additional information about fees paid to insurance broker | LTD, LIFE AND ADD ADMIN FEE |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $224,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ASF4 |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0ASF4 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $3,403 | | Total amount of fees paid to insurance company | USD $1,889 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $36,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,403 | | Amount paid for insurance broker fees | 1619 | | Additional information about fees paid to insurance broker | OTHER FEES | | Insurance broker organization code? | 3 |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 03306 |
| Policy instance | 3 |
| Insurance contract or identification number | 03306 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $3,098 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,098 | | Insurance broker organization code? | 3 | | Insurance broker name | TFG FINANCIAL GROUP BENEFITS LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ASF4 |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0ASF4 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $3,276 | | Total amount of fees paid to insurance company | USD $570 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,276 | | Amount paid for insurance broker fees | 570 | | Additional information about fees paid to insurance broker | OTHER AGENT FEE | | Insurance broker organization code? | 3 | | Insurance broker name | TFG FINANCIAL GROUP BENEFITS LLC |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of fees paid to insurance company | USD $6,032 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $271,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6032 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | TFG FINANCIAL GROUP BENEFITS LLC |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 03306 |
| Policy instance | 3 |
| Insurance contract or identification number | 03306 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $1,441 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,441 | | Insurance broker organization code? | 3 | | Insurance broker name | TFG FINANCIAL GROUP BENEFITS LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0ASF4 |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0ASF4 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $3,255 | | Total amount of fees paid to insurance company | USD $562 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,099 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,255 | | Amount paid for insurance broker fees | 562 | | Additional information about fees paid to insurance broker | REINSURANCE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | TFG FINANCIAL GROUP BENEFITS LLC |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $231,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 213202 |
| Policy instance | 3 |
| Insurance contract or identification number | 213202 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $3,041 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,914 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 03306 |
| Policy instance | 2 |
| Insurance contract or identification number | 03306 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $1,595 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SPECTRUM UNDERWRITING MANAGERS, INC. (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | S710308 |
| Policy instance | 1 |
| Insurance contract or identification number | S710308 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $369,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 213202 |
| Policy instance | 3 |
| Insurance contract or identification number | 213202 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $3,059 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 03306 |
| Policy instance | 2 |
| Insurance contract or identification number | 03306 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $1,617 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | BASIC AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $21,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16445 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL16445 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $4,761 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $518,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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