DOUG ASHY BUILDING MATERIALS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN
401k plan membership statisitcs for DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN
Measure | Date | Value |
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2021: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 182 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 180 |
Total of all active and inactive participants | 2021-01-01 | 180 |
2020: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 195 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 182 |
Total of all active and inactive participants | 2020-01-01 | 182 |
2019: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 206 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 206 |
Total of all active and inactive participants | 2019-01-01 | 206 |
2018: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 182 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 206 |
Total of all active and inactive participants | 2018-01-01 | 206 |
2017: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 175 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 182 |
Total of all active and inactive participants | 2017-01-01 | 182 |
2016: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 200 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 175 |
Total of all active and inactive participants | 2016-01-01 | 175 |
2015: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 200 |
Total of all active and inactive participants | 2015-01-01 | 200 |
2014: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 170 |
Total of all active and inactive participants | 2014-01-01 | 170 |
2013: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 150 |
Total of all active and inactive participants | 2013-01-01 | 150 |
2012: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 147 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 150 |
Total of all active and inactive participants | 2012-01-01 | 150 |
2011: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 157 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 147 |
Total of all active and inactive participants | 2011-01-01 | 147 |
2010: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 158 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 157 |
Total of all active and inactive participants | 2010-01-01 | 157 |
2009: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 133 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 158 |
Total of all active and inactive participants | 2009-01-01 | 158 |
2021: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Submission has been amended | Yes |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Submission has been amended | Yes |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses |
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2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Plan funding arrangement – Insurance | Yes |
2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-01-01 | Plan benefit arrangement – Insurance | Yes |
2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2010 form 5500 responses |
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2010-01-01 | Type of plan entity | Single employer plan |
2010-01-01 | Plan funding arrangement – Insurance | Yes |
2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-01-01 | Plan benefit arrangement – Insurance | Yes |
2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: DOUG ASHY BUILDING MATERIALS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 ) |
Policy contract number | VARIOUS |
Policy instance | 6 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 5 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,492 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 1 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,062 | Insurance broker organization code? | 3 |
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DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
Policy contract number | 03584 |
Policy instance | 1 |
Insurance contract or identification number | 03584 | Number of Individuals Covered | 279 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $9,753 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $82,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,296 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | MX604 |
Policy instance | 2 |
Insurance contract or identification number | MX604 | Number of Individuals Covered | 102 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $9,032 | Total amount of fees paid to insurance company | USD $25 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $96,302 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,309 | Amount paid for insurance broker fees | 10 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APQX |
Policy instance | 3 |
Insurance contract or identification number | G000APQX | Number of Individuals Covered | 181 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2022-01-01 | Total amount of commissions paid to insurance broker | USD $8,955 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $46,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,955 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD/OTHER COMPENSATION | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01514-21 |
Policy instance | 4 |
Insurance contract or identification number | LGS01514-21 | Number of Individuals Covered | 180 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $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 broker | N/A | Insurance broker organization code? | 3 |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 51922 |
Policy instance | 5 |
Insurance contract or identification number | 51922 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 1 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,251 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 008690774 |
Policy instance | 6 |
Insurance contract or identification number | 008690774 | Number of Individuals Covered | 1 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 1 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 |
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MML BAYSTATE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70416 ) |
Policy contract number | VARIOUS |
Policy instance | 5 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 5 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,135 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 1 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $808 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01514-20 |
Policy instance | 4 |
Insurance contract or identification number | LGS01514-20 | Number of Individuals Covered | 182 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $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 broker | N/A | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APQX |
Policy instance | 3 |
Insurance contract or identification number | G000APQX | Number of Individuals Covered | 179 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2021-01-01 | Total amount of commissions paid to insurance broker | USD $8,463 | Total amount of fees paid to insurance company | USD $3,335 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $44,429 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,377 | Amount paid for insurance broker fees | 3335 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD/OTHER COMPENSATION | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | MX604 |
Policy instance | 2 |
Insurance contract or identification number | MX604 | Number of Individuals Covered | 116 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $11,825 | Total amount of fees paid to insurance company | USD $175 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,211 | Amount paid for insurance broker fees | 73 | Insurance broker organization code? | 3 |
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DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
Policy contract number | 03584 |
Policy instance | 1 |
Insurance contract or identification number | 03584 | Number of Individuals Covered | 293 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $8,595 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $82,424 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,595 | Insurance broker organization code? | 3 |
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DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
Policy contract number | 03584 |
Policy instance | 1 |
Insurance contract or identification number | 03584 | Number of Individuals Covered | 294 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $8,702 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $87,021 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,702 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | MX604 |
Policy instance | 2 |
Insurance contract or identification number | MX604 | Number of Individuals Covered | 122 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $13,805 | Total amount of fees paid to insurance company | USD $123 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $131,800 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,884 | Amount paid for insurance broker fees | 42 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APQX |
Policy instance | 3 |
Insurance contract or identification number | G000APQX | Number of Individuals Covered | 195 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2020-01-01 | Total amount of commissions paid to insurance broker | USD $9,169 | Total amount of fees paid to insurance company | USD $3,613 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $48,116 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,169 | Amount paid for insurance broker fees | 3613 | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01514-19 |
Policy instance | 4 |
Insurance contract or identification number | LGS01514-19 | Number of Individuals Covered | 195 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $20,399 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $291,419 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,399 | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01514-18 |
Policy instance | 4 |
Insurance contract or identification number | LGS01514-18 | Number of Individuals Covered | 206 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $63,294 | Total amount of fees paid to insurance company | USD $29,537 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $421,958 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63,294 | Amount paid for insurance broker fees | 29537 | Insurance broker organization code? | 3 |
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ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | 417004410966 |
Policy instance | 5 |
Insurance contract or identification number | 417004410966 | Number of Individuals Covered | 200 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-06-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | STOP LOSS | Welfare Benefit Premiums Paid to Carrier | USD $387,833 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01514-17 |
Policy instance | 4 |
Insurance contract or identification number | LGS01514-17 | Number of Individuals Covered | 205 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $58,211 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $388,072 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $58,211 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | STEALTH PARTNER GROUP |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000APQX |
Policy instance | 3 |
Insurance contract or identification number | G000APQX | Number of Individuals Covered | 206 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2018-01-01 | Total amount of commissions paid to insurance broker | USD $9,390 | Total amount of fees paid to insurance company | USD $2,270 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $49,306 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,390 | Amount paid for insurance broker fees | 2270 | Insurance broker organization code? | 3 | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | MX604 |
Policy instance | 2 |
Insurance contract or identification number | MX604 | Number of Individuals Covered | 147 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $19,845 | Total amount of fees paid to insurance company | USD $1,040 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,202 | Amount paid for insurance broker fees | 427 | Insurance broker organization code? | 3 | Insurance broker name | RICKY C PISANI |
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DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
Policy contract number | 03584 |
Policy instance | 1 |
Insurance contract or identification number | 03584 | Number of Individuals Covered | 308 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $8,810 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $88,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,810 | Insurance broker organization code? | 3 | Insurance broker name | HUB INTERNATIONAL TEXAS INC. |
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