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BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 401k Plan overview

Plan NameBAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST
Plan identification number 501

BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BAKER MANUFACTURING COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:BAKER MANUFACTURING COMPANY, INC.
Employer identification number (EIN):720509680
NAIC Classification:337000

Additional information about BAKER MANUFACTURING COMPANY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2015-07-27
Company Identification Number: 0802261105
Legal Registered Office Address: PO BOX 4120

PINEVILLE
United States of America (USA)
71361

More information about BAKER MANUFACTURING COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-06-01
5012018-06-01
5012017-06-01CATHY GRANT
5012016-06-01SANDRA MCQUAIN
5012015-06-01SANDRA MCQUAIN
5012014-06-01SANDRA MCQUAIN
5012013-06-01SANDRA MCQUAIN
5012012-06-01SANDRA MCQUAIN
5012011-06-01FRANKLIN DEGRAW
5012010-06-01FRANKLIN DEGRAW
5012009-06-01FRANKLIN DEGRAW

Plan Statistics for BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST

401k plan membership statisitcs for BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST

Measure Date Value
2019: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year2019-06-010
Total number of active participants reported on line 7a of the Form 55002019-06-010
Total of all active and inactive participants2019-06-010
2018: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year2018-06-0171
Total number of active participants reported on line 7a of the Form 55002018-06-010
Total of all active and inactive participants2018-06-010
2017: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-06-0170
Total number of active participants reported on line 7a of the Form 55002017-06-0171
Total of all active and inactive participants2017-06-0171
2016: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-06-01103
Total number of active participants reported on line 7a of the Form 55002016-06-0170
Total of all active and inactive participants2016-06-0170
2015: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-06-01103
Total number of active participants reported on line 7a of the Form 55002015-06-01103
Total of all active and inactive participants2015-06-01103
2014: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-06-0195
Total number of active participants reported on line 7a of the Form 55002014-06-01103
Total of all active and inactive participants2014-06-01103
2013: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-06-0196
Total number of active participants reported on line 7a of the Form 55002013-06-0195
Total of all active and inactive participants2013-06-0195
2012: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-06-0192
Total number of active participants reported on line 7a of the Form 55002012-06-0196
Total of all active and inactive participants2012-06-0196
2011: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-06-0195
Total number of active participants reported on line 7a of the Form 55002011-06-0192
Total of all active and inactive participants2011-06-0192
2010: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-06-0190
Total number of active participants reported on line 7a of the Form 55002010-06-0195
Total of all active and inactive participants2010-06-0195
2009: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-06-0197
Total number of active participants reported on line 7a of the Form 55002009-06-0190
Total of all active and inactive participants2009-06-0190

Financial Data on BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST

Measure Date Value
2020 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2020 401k financial data
Total income from all sources2020-04-21$3,962
Expenses. Total of all expenses incurred2020-04-21$4,295
Benefits paid (including direct rollovers)2020-04-21$4,216
Total plan assets at end of year2020-04-21$0
Total plan assets at beginning of year2020-04-21$333
Expenses. Other expenses not covered elsewhere2020-04-21$79
Other income received2020-04-21$3,962
Net income (gross income less expenses)2020-04-21$-333
Net plan assets at end of year (total assets less liabilities)2020-04-21$0
Net plan assets at beginning of year (total assets less liabilities)2020-04-21$333
2019 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2019 401k financial data
Total income from all sources2019-05-31$576,847
Expenses. Total of all expenses incurred2019-05-31$581,966
Benefits paid (including direct rollovers)2019-05-31$562,744
Total plan assets at end of year2019-05-31$333
Total plan assets at beginning of year2019-05-31$5,452
Expenses. Other expenses not covered elsewhere2019-05-31$19,222
Net income (gross income less expenses)2019-05-31$-5,119
Net plan assets at end of year (total assets less liabilities)2019-05-31$333
Net plan assets at beginning of year (total assets less liabilities)2019-05-31$5,452
Total contributions received or receivable from employer(s)2019-05-31$576,847
2018 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 401k financial data
Total income from all sources2018-05-31$833,275
Expenses. Total of all expenses incurred2018-05-31$863,390
Benefits paid (including direct rollovers)2018-05-31$830,365
Total plan assets at end of year2018-05-31$5,452
Total plan assets at beginning of year2018-05-31$35,567
Expenses. Other expenses not covered elsewhere2018-05-31$33,025
Other income received2018-05-31$45
Net income (gross income less expenses)2018-05-31$-30,115
Net plan assets at end of year (total assets less liabilities)2018-05-31$5,452
Net plan assets at beginning of year (total assets less liabilities)2018-05-31$35,567
Total contributions received or receivable from employer(s)2018-05-31$833,230
2017 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-05-31$1,076,070
Expenses. Total of all expenses incurred2017-05-31$1,064,001
Benefits paid (including direct rollovers)2017-05-31$1,016,969
Total plan assets at end of year2017-05-31$35,567
Total plan assets at beginning of year2017-05-31$23,498
Expenses. Other expenses not covered elsewhere2017-05-31$47,032
Other income received2017-05-31$100,250
Net income (gross income less expenses)2017-05-31$12,069
Net plan assets at end of year (total assets less liabilities)2017-05-31$35,567
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$23,498
Total contributions received or receivable from employer(s)2017-05-31$975,820
2016 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-05-31$1,444,555
Expenses. Total of all expenses incurred2016-05-31$1,431,078
Benefits paid (including direct rollovers)2016-05-31$1,373,676
Total plan assets at end of year2016-05-31$23,498
Total plan assets at beginning of year2016-05-31$10,021
Expenses. Other expenses not covered elsewhere2016-05-31$57,402
Other income received2016-05-31$135,841
Net income (gross income less expenses)2016-05-31$13,477
Net plan assets at end of year (total assets less liabilities)2016-05-31$23,498
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$10,021
Total contributions received or receivable from employer(s)2016-05-31$1,308,714
2015 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-05-31$1,218,021
Expenses. Total of all expenses incurred2015-05-31$1,228,951
Benefits paid (including direct rollovers)2015-05-31$1,169,937
Total plan assets at end of year2015-05-31$10,021
Total plan assets at beginning of year2015-05-31$20,951
Expenses. Other expenses not covered elsewhere2015-05-31$59,014
Net income (gross income less expenses)2015-05-31$-10,930
Net plan assets at end of year (total assets less liabilities)2015-05-31$10,021
Net plan assets at beginning of year (total assets less liabilities)2015-05-31$20,951
Total contributions received or receivable from employer(s)2015-05-31$1,218,021
2014 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-05-31$1,200,682
Expenses. Total of all expenses incurred2014-05-31$1,236,185
Benefits paid (including direct rollovers)2014-05-31$1,184,074
Total plan assets at end of year2014-05-31$20,951
Total plan assets at beginning of year2014-05-31$56,454
Expenses. Other expenses not covered elsewhere2014-05-31$52,111
Other income received2014-05-31$95,381
Net income (gross income less expenses)2014-05-31$-35,503
Net plan assets at end of year (total assets less liabilities)2014-05-31$20,951
Net plan assets at beginning of year (total assets less liabilities)2014-05-31$56,454
Total contributions received or receivable from employer(s)2014-05-31$1,105,301
2013 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-05-31$998,652
Expenses. Total of all expenses incurred2013-05-31$948,193
Benefits paid (including direct rollovers)2013-05-31$884,848
Total plan assets at end of year2013-05-31$56,454
Total plan assets at beginning of year2013-05-31$5,995
Expenses. Other expenses not covered elsewhere2013-05-31$63,345
Other income received2013-05-31$4
Net income (gross income less expenses)2013-05-31$50,459
Net plan assets at end of year (total assets less liabilities)2013-05-31$56,454
Net plan assets at beginning of year (total assets less liabilities)2013-05-31$5,995
Total contributions received or receivable from employer(s)2013-05-31$998,648
2012 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-05-31$697,190
Expenses. Total of all expenses incurred2012-05-31$713,069
Benefits paid (including direct rollovers)2012-05-31$656,690
Total plan assets at end of year2012-05-31$5,995
Total plan assets at beginning of year2012-05-31$21,874
Other income received2012-05-31$36
Net income (gross income less expenses)2012-05-31$-15,879
Net plan assets at end of year (total assets less liabilities)2012-05-31$5,995
Net plan assets at beginning of year (total assets less liabilities)2012-05-31$21,874
Total contributions received or receivable from employer(s)2012-05-31$697,154
Expenses. Administrative service providers (salaries,fees and commissions)2012-05-31$56,379
2011 : BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-05-31$923,799
Expenses. Total of all expenses incurred2011-05-31$923,295
Benefits paid (including direct rollovers)2011-05-31$874,873
Total plan assets at end of year2011-05-31$21,874
Total plan assets at beginning of year2011-05-31$21,370
Other income received2011-05-31$25,966
Net income (gross income less expenses)2011-05-31$504
Net plan assets at end of year (total assets less liabilities)2011-05-31$21,874
Net plan assets at beginning of year (total assets less liabilities)2011-05-31$21,370
Total contributions received or receivable from employer(s)2011-05-31$897,833
Expenses. Administrative service providers (salaries,fees and commissions)2011-05-31$48,422

Form 5500 Responses for BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST

2019: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01This submission is the final filingYes
2019-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-06-01Plan funding arrangement – TrustYes
2019-06-01Plan benefit arrangement - TrustYes
2018: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – TrustYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement - TrustYes
2017: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – TrustYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement - TrustYes
2016: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – TrustYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement - TrustYes
2015: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement - TrustYes
2014: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement - TrustYes
2013: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement - TrustYes
2012: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement - TrustYes
2011: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement - TrustYes
2010: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – TrustYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement - TrustYes
2009: BAKER MANUFACTURING CO., INC. EMPLOYEE BENEFIT PLAN AND TRUST 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01This submission is the final filingNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered0
Insurance policy start date2018-06-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $15,884
Total amount of fees paid to insurance companyUSD $15,088
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,884
Amount paid for insurance broker fees15088
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered0
Insurance policy start date2018-06-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $752
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $752
Insurance broker organization code?5
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered0
Insurance policy start date2018-06-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $2,074
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $6,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,074
Insurance broker organization code?5
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $25,991
Total amount of fees paid to insurance companyUSD $28,856
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $173,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered71
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $1,130
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $3,264
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: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,510
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $7,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,510
Insurance broker organization code?5
Insurance broker nameIMA, INC.
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2015-06-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $673
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $3,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $673
Insurance broker organization code?5
Insurance broker nameIMA, INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $30,723
Total amount of fees paid to insurance companyUSD $41,143
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $225,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,723
Amount paid for insurance broker fees33805
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameJOHN BREWER
ACTIVENET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $3,679
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $6,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,679
Insurance broker organization code?5
Insurance broker nameIMA, INC.
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,223
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $8,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,223
Insurance broker organization code?5
Insurance broker nameIMA, INC.
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,245
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $8,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,245
Insurance broker organization code?5
Insurance broker nameIMA, INC.
ACTIVENET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 6
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $4,316
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $8,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,316
Insurance broker organization code?5
Insurance broker nameIMA, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,350
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $6,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,350
Insurance broker organization code?5
Insurance broker nameIMA, INC.
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2014-06-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $55
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55
Insurance broker organization code?5
Insurance broker nameIMA, INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered103
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $33,962
Total amount of fees paid to insurance companyUSD $43,192
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $226,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,962
Amount paid for insurance broker fees35722
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameJOHN BREWER
ACTIVENET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 6
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $3,528
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $6,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,528
Insurance broker organization code?5
Insurance broker nameIMA, INC.
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $1,118
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $7,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,118
Insurance broker organization code?5
Insurance broker nameIMA, INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $26,841
Total amount of fees paid to insurance companyUSD $39,081
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $178,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,841
Amount paid for insurance broker fees32373
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameJOHN BREWER
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $615
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $615
Insurance broker organization code?5
Insurance broker nameIMA, INC.
IHEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $1,677
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH BENEFIT MANAGEMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,677
Insurance broker organization code?5
Insurance broker nameIMA, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $1,089
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,089
Insurance broker organization code?5
Insurance broker nameIMA, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $1,087
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,087
Insurance broker organization code?5
Insurance broker nameIMA, INC.
ACTIVENET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 6
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2013-01-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $3,619
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $6,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,619
Insurance broker organization code?5
Insurance broker nameIMA, INC.
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2013-01-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $1,123
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $6,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,123
Insurance broker organization code?5
Insurance broker nameIMA, INC.
IHEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $1,685
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH BENEFIT MANAGEMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,685
Insurance broker organization code?5
Insurance broker nameIMA, INC.
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $26,921
Total amount of fees paid to insurance companyUSD $37,051
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $179,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,921
Amount paid for insurance broker fees30313
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameJOHN BREWER
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered96
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $618
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $618
Insurance broker organization code?5
Insurance broker nameIMA, INC.
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 7
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2012-01-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $453
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $2,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract numberNOT AVAILABLE
Policy instance 6
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $24,212
Total amount of fees paid to insurance companyUSD $34,457
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $161,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHSMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $49
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACTIVENET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 8
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2012-01-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $1,586
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $2,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
IHEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $1,593
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH BENEFIT MANAGEMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $692
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $3,100
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: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $1,032
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered92
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $584
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ALLIANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 68136 )
Policy contract numberAULM0873
Policy instance 6
Insurance contract or identification numberAULM0873
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $25,172
Total amount of fees paid to insurance companyUSD $30,081
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $167,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,172
Amount paid for insurance broker fees25557
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameJOHN BREWER
HEALTHSMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $15
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $72
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
IHEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $1,697
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedHEALTH BENEFIT MANAGEMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,697
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $622
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $622
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $1,287
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $5,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,287
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered95
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $1,001
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD AND D
Welfare Benefit Premiums Paid to CarrierUSD $4,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,001
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT ADMINISTRATORS

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