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DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameDOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN
Plan identification number 502

DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

DOUG ASHY BUILDING MATERIALS, INC. has sponsored the creation of one or more 401k plans.

Company Name:DOUG ASHY BUILDING MATERIALS, INC.
Employer identification number (EIN):720537573
NAIC Classification:444110
NAIC Description:Home Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01ROCKY TRAHAN2022-11-15
5022020-01-01ROCKY TRAHAN2022-08-22
5022019-01-01ROCKY TRAHAN2020-10-15
5022019-01-01ROCKY TRAHAN2020-10-21
5022018-01-01ROCKY TRAHAN2019-09-23
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01
5022012-01-01STEVE ASHY
5022011-01-01STEVE ASHY
5022010-01-01STEVE ASHY
5022009-01-01STEVE ASHY

Plan Statistics for DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2021: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01182
Total number of active participants reported on line 7a of the Form 55002021-01-01180
Total of all active and inactive participants2021-01-01180
2020: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01195
Total number of active participants reported on line 7a of the Form 55002020-01-01182
Total of all active and inactive participants2020-01-01182
2019: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01206
Total number of active participants reported on line 7a of the Form 55002019-01-01206
Total of all active and inactive participants2019-01-01206
2018: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01182
Total number of active participants reported on line 7a of the Form 55002018-01-01206
Total of all active and inactive participants2018-01-01206
2017: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01175
Total number of active participants reported on line 7a of the Form 55002017-01-01182
Total of all active and inactive participants2017-01-01182
2016: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01200
Total number of active participants reported on line 7a of the Form 55002016-01-01175
Total of all active and inactive participants2016-01-01175
2015: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01170
Total number of active participants reported on line 7a of the Form 55002015-01-01200
Total of all active and inactive participants2015-01-01200
2014: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01150
Total number of active participants reported on line 7a of the Form 55002014-01-01170
Total of all active and inactive participants2014-01-01170
2013: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01150
Total number of active participants reported on line 7a of the Form 55002013-01-01150
Total of all active and inactive participants2013-01-01150
2012: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01147
Total number of active participants reported on line 7a of the Form 55002012-01-01150
Total of all active and inactive participants2012-01-01150
2011: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01157
Total number of active participants reported on line 7a of the Form 55002011-01-01147
Total of all active and inactive participants2011-01-01147
2010: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01158
Total number of active participants reported on line 7a of the Form 55002010-01-01157
Total of all active and inactive participants2010-01-01157
2009: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01133
Total number of active participants reported on line 7a of the Form 55002009-01-01158
Total of all active and inactive participants2009-01-01158

Form 5500 Responses for DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN

2021: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
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: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT 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: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract numberVARIOUS
Policy instance 6
Insurance contract or identification numberVARIOUS
Number of Individuals Covered5
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,492
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Life 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 $1,062
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number03584
Policy instance 1
Insurance contract or identification number03584
Number of Individuals Covered279
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,753
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,296
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberMX604
Policy instance 2
Insurance contract or identification numberMX604
Number of Individuals Covered102
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,032
Total amount of fees paid to insurance companyUSD $25
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,309
Amount paid for insurance broker fees10
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000APQX
Policy instance 3
Insurance contract or identification numberG000APQX
Number of Individuals Covered181
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $8,955
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $46,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,955
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD/OTHER COMPENSATION
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01514-21
Policy instance 4
Insurance contract or identification numberLGS01514-21
Number of Individuals Covered180
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $338,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number51922
Policy instance 5
Insurance contract or identification number51922
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number008690774
Policy instance 6
Insurance contract or identification number008690774
Number of Individuals Covered1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 )
Policy contract numberVARIOUS
Policy instance 5
Insurance contract or identification numberVARIOUS
Number of Individuals Covered5
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,135
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Life 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 $808
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01514-20
Policy instance 4
Insurance contract or identification numberLGS01514-20
Number of Individuals Covered182
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $313,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000APQX
Policy instance 3
Insurance contract or identification numberG000APQX
Number of Individuals Covered179
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $8,463
Total amount of fees paid to insurance companyUSD $3,335
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $44,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,377
Amount paid for insurance broker fees3335
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD/OTHER COMPENSATION
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberMX604
Policy instance 2
Insurance contract or identification numberMX604
Number of Individuals Covered116
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,825
Total amount of fees paid to insurance companyUSD $175
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,211
Amount paid for insurance broker fees73
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number03584
Policy instance 1
Insurance contract or identification number03584
Number of Individuals Covered293
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,595
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,595
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number03584
Policy instance 1
Insurance contract or identification number03584
Number of Individuals Covered294
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,702
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,702
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberMX604
Policy instance 2
Insurance contract or identification numberMX604
Number of Individuals Covered122
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,805
Total amount of fees paid to insurance companyUSD $123
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,884
Amount paid for insurance broker fees42
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000APQX
Policy instance 3
Insurance contract or identification numberG000APQX
Number of Individuals Covered195
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $9,169
Total amount of fees paid to insurance companyUSD $3,613
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $48,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,169
Amount paid for insurance broker fees3613
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01514-19
Policy instance 4
Insurance contract or identification numberLGS01514-19
Number of Individuals Covered195
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $20,399
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $291,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,399
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01514-18
Policy instance 4
Insurance contract or identification numberLGS01514-18
Number of Individuals Covered206
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $63,294
Total amount of fees paid to insurance companyUSD $29,537
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $421,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,294
Amount paid for insurance broker fees29537
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number417004410966
Policy instance 5
Insurance contract or identification number417004410966
Number of Individuals Covered200
Insurance policy start date2017-06-01
Insurance policy end date2018-06-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $387,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameHUB INTERNATIONAL TEXAS INC.
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01514-17
Policy instance 4
Insurance contract or identification numberLGS01514-17
Number of Individuals Covered205
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $58,211
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $388,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,211
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSTEALTH PARTNER GROUP
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000APQX
Policy instance 3
Insurance contract or identification numberG000APQX
Number of Individuals Covered206
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $9,390
Total amount of fees paid to insurance companyUSD $2,270
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $49,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,390
Amount paid for insurance broker fees2270
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL TEXAS INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberMX604
Policy instance 2
Insurance contract or identification numberMX604
Number of Individuals Covered147
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $19,845
Total amount of fees paid to insurance companyUSD $1,040
Temporary Disability 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 $6,202
Amount paid for insurance broker fees427
Insurance broker organization code?3
Insurance broker nameRICKY C PISANI
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number03584
Policy instance 1
Insurance contract or identification number03584
Number of Individuals Covered308
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,810
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,810
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL TEXAS INC.

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