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BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 401k Plan overview

Plan NameBILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST
Plan identification number 502

BILL & RALPH'S, INC. EMPLOYEES 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

BILL & RALPH'S, INC. has sponsored the creation of one or more 401k plans.

Company Name:BILL & RALPH'S, INC.
Employer identification number (EIN):720572271
NAIC Classification:424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022024-01-01CASEY CARTER
5022023-01-01
5022023-01-01CASEY CARTER
5022022-01-01
5022022-01-01CASEY CARTER
5022021-01-01
5022021-01-01JAKE HEARNSBERGER
5022020-01-01
5022019-01-01
5022017-01-01JAKE HEARNSBERGER
5022016-01-01JAKE HEARNSBERGER
5022015-01-01JAKE HEARNSBERGER
5022014-01-01JAKE HEARNSBERGER
5022013-01-01JAKE HEARNSBERGER
5022012-01-01CLIFF CARTER
5022011-01-01CLIFF CARTER
5022010-01-01CLIFF CARTER
5022009-01-01CLIFF CARTER

Plan Statistics for BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST

401k plan membership statisitcs for BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST

Measure Date Value
2023: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2023 401k membership
Total participants, beginning-of-year2023-01-0154
Total number of active participants reported on line 7a of the Form 55002023-01-0150
Total of all active and inactive participants2023-01-0150
2022: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-0155
Total number of active participants reported on line 7a of the Form 55002022-01-0154
Total of all active and inactive participants2022-01-0154
2021: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-0161
Total number of active participants reported on line 7a of the Form 55002021-01-0155
Total of all active and inactive participants2021-01-0155
2020: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-0161
Total number of active participants reported on line 7a of the Form 55002020-01-0161
Total of all active and inactive participants2020-01-0161
2019: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-0165
Total number of active participants reported on line 7a of the Form 55002019-01-0161
Total of all active and inactive participants2019-01-0161
2017: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0173
Total number of active participants reported on line 7a of the Form 55002017-01-0168
Total of all active and inactive participants2017-01-0168
2016: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0175
Total number of active participants reported on line 7a of the Form 55002016-01-0173
Total of all active and inactive participants2016-01-0173
2015: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0166
Total number of active participants reported on line 7a of the Form 55002015-01-0175
Total of all active and inactive participants2015-01-0175
2014: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0170
Total number of active participants reported on line 7a of the Form 55002014-01-0166
Total of all active and inactive participants2014-01-0166
2013: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0179
Total number of active participants reported on line 7a of the Form 55002013-01-0170
Total of all active and inactive participants2013-01-0170
2012: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0182
Total number of active participants reported on line 7a of the Form 55002012-01-0179
Total of all active and inactive participants2012-01-0179
2011: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0185
Total number of active participants reported on line 7a of the Form 55002011-01-0182
Total of all active and inactive participants2011-01-0182
2010: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-0178
Total number of active participants reported on line 7a of the Form 55002010-01-0185
Total of all active and inactive participants2010-01-0185
2009: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0173
Total number of active participants reported on line 7a of the Form 55002009-01-0178
Total of all active and inactive participants2009-01-0178

Financial Data on BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST

Measure Date Value
2023 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2023 401k financial data
Total income from all sources2023-12-31$480,122
Expenses. Total of all expenses incurred2023-12-31$430,965
Benefits paid (including direct rollovers)2023-12-31$409,340
Total plan assets at end of year2023-12-31$116,016
Total plan assets at beginning of year2023-12-31$66,859
Expenses. Other expenses not covered elsewhere2023-12-31$21,625
Net income (gross income less expenses)2023-12-31$49,157
Net plan assets at end of year (total assets less liabilities)2023-12-31$116,016
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$66,859
Total contributions received or receivable from employer(s)2023-12-31$480,122
2022 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 401k financial data
Total income from all sources2022-12-31$597,735
Expenses. Total of all expenses incurred2022-12-31$533,378
Benefits paid (including direct rollovers)2022-12-31$511,430
Total plan assets at end of year2022-12-31$66,859
Total plan assets at beginning of year2022-12-31$2,502
Expenses. Other expenses not covered elsewhere2022-12-31$21,948
Other income received2022-12-31$76,738
Net income (gross income less expenses)2022-12-31$64,357
Net plan assets at end of year (total assets less liabilities)2022-12-31$66,859
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$2,502
Total contributions received or receivable from employer(s)2022-12-31$520,997
2021 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2021 401k financial data
Total income from all sources2021-12-31$881,488
Expenses. Total of all expenses incurred2021-12-31$942,540
Benefits paid (including direct rollovers)2021-12-31$919,882
Total plan assets at end of year2021-12-31$2,502
Total plan assets at beginning of year2021-12-31$63,554
Expenses. Other expenses not covered elsewhere2021-12-31$22,658
Other income received2021-12-31$63,087
Net income (gross income less expenses)2021-12-31$-61,052
Net plan assets at end of year (total assets less liabilities)2021-12-31$2,502
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$63,554
Total contributions received or receivable from employer(s)2021-12-31$818,401
2020 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2020 401k financial data
Total income from all sources2020-12-31$840,827
Expenses. Total of all expenses incurred2020-12-31$826,077
Benefits paid (including direct rollovers)2020-12-31$778,218
Total plan assets at end of year2020-12-31$63,554
Total plan assets at beginning of year2020-12-31$48,804
Expenses. Other expenses not covered elsewhere2020-12-31$47,859
Other income received2020-12-31$6,623
Net income (gross income less expenses)2020-12-31$14,750
Net plan assets at end of year (total assets less liabilities)2020-12-31$63,554
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$48,804
Total contributions received or receivable from employer(s)2020-12-31$834,204
2019 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2019 401k financial data
Total income from all sources2019-12-31$890,934
Expenses. Total of all expenses incurred2019-12-31$849,538
Benefits paid (including direct rollovers)2019-12-31$826,490
Total plan assets at end of year2019-12-31$48,804
Total plan assets at beginning of year2019-12-31$7,408
Expenses. Other expenses not covered elsewhere2019-12-31$23,048
Net income (gross income less expenses)2019-12-31$41,396
Net plan assets at end of year (total assets less liabilities)2019-12-31$48,804
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$7,408
Total contributions received or receivable from employer(s)2019-12-31$890,934
2018 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2018 401k financial data
Total income from all sources2018-12-31$795,394
Expenses. Total of all expenses incurred2018-12-31$792,300
Benefits paid (including direct rollovers)2018-12-31$763,766
Total plan assets at end of year2018-12-31$7,408
Total plan assets at beginning of year2018-12-31$4,314
Expenses. Other expenses not covered elsewhere2018-12-31$28,534
Other income received2018-12-31$48,441
Net income (gross income less expenses)2018-12-31$3,094
Net plan assets at end of year (total assets less liabilities)2018-12-31$7,408
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$4,314
Total contributions received or receivable from employer(s)2018-12-31$746,953
2017 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-12-31$909,690
Expenses. Total of all expenses incurred2017-12-31$921,015
Benefits paid (including direct rollovers)2017-12-31$889,502
Total plan assets at end of year2017-12-31$4,314
Total plan assets at beginning of year2017-12-31$15,639
Expenses. Other expenses not covered elsewhere2017-12-31$31,513
Other income received2017-12-31$120,066
Net income (gross income less expenses)2017-12-31$-11,325
Net plan assets at end of year (total assets less liabilities)2017-12-31$4,314
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$15,639
Total contributions received or receivable from employer(s)2017-12-31$789,624
2016 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$799,306
Expenses. Total of all expenses incurred2016-12-31$948,340
Benefits paid (including direct rollovers)2016-12-31$912,174
Total plan assets at end of year2016-12-31$15,639
Total plan assets at beginning of year2016-12-31$164,673
Expenses. Other expenses not covered elsewhere2016-12-31$36,166
Other income received2016-12-31$38,119
Net income (gross income less expenses)2016-12-31$-149,034
Net plan assets at end of year (total assets less liabilities)2016-12-31$15,639
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$164,673
Total contributions received or receivable from employer(s)2016-12-31$761,187
2015 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$931,515
Expenses. Total of all expenses incurred2015-12-31$1,047,131
Benefits paid (including direct rollovers)2015-12-31$1,007,563
Total plan assets at end of year2015-12-31$164,673
Total plan assets at beginning of year2015-12-31$280,289
Expenses. Other expenses not covered elsewhere2015-12-31$39,568
Other income received2015-12-31$228,251
Net income (gross income less expenses)2015-12-31$-115,616
Net plan assets at end of year (total assets less liabilities)2015-12-31$164,673
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$280,289
Total contributions received or receivable from employer(s)2015-12-31$703,264
2014 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$687,858
Expenses. Total of all expenses incurred2014-12-31$596,837
Benefits paid (including direct rollovers)2014-12-31$557,950
Total plan assets at end of year2014-12-31$280,289
Total plan assets at beginning of year2014-12-31$189,268
Expenses. Other expenses not covered elsewhere2014-12-31$38,887
Other income received2014-12-31$124,939
Net income (gross income less expenses)2014-12-31$91,021
Net plan assets at end of year (total assets less liabilities)2014-12-31$280,289
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$189,268
Total contributions received or receivable from employer(s)2014-12-31$562,919
2013 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$704,178
Expenses. Total of all expenses incurred2013-12-31$719,860
Benefits paid (including direct rollovers)2013-12-31$682,337
Total plan assets at end of year2013-12-31$189,268
Total plan assets at beginning of year2013-12-31$204,950
Expenses. Other expenses not covered elsewhere2013-12-31$37,523
Other income received2013-12-31$87,919
Net income (gross income less expenses)2013-12-31$-15,682
Net plan assets at end of year (total assets less liabilities)2013-12-31$189,268
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$204,950
Total contributions received or receivable from employer(s)2013-12-31$616,259
2012 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-12-31$1,088,631
Expenses. Total of all expenses incurred2012-12-31$1,129,629
Benefits paid (including direct rollovers)2012-12-31$1,078,884
Total plan assets at end of year2012-12-31$204,950
Total plan assets at beginning of year2012-12-31$245,948
Expenses. Other expenses not covered elsewhere2012-12-31$50,745
Other income received2012-12-31$338,147
Net income (gross income less expenses)2012-12-31$-40,998
Net plan assets at end of year (total assets less liabilities)2012-12-31$204,950
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$245,948
Total contributions received or receivable from employer(s)2012-12-31$750,484
2011 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-12-31$870,623
Expenses. Total of all expenses incurred2011-12-31$765,414
Benefits paid (including direct rollovers)2011-12-31$717,974
Total plan assets at end of year2011-12-31$245,948
Total plan assets at beginning of year2011-12-31$140,739
Other income received2011-12-31$167,249
Net income (gross income less expenses)2011-12-31$105,209
Net plan assets at end of year (total assets less liabilities)2011-12-31$245,948
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$140,739
Total contributions received or receivable from employer(s)2011-12-31$703,374
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$47,440
2010 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2010 401k financial data
Total income from all sources2010-12-31$727,075
Expenses. Total of all expenses incurred2010-12-31$768,087
Benefits paid (including direct rollovers)2010-12-31$720,893
Total plan assets at end of year2010-12-31$140,739
Total plan assets at beginning of year2010-12-31$181,751
Other income received2010-12-31$123,056
Net income (gross income less expenses)2010-12-31$-41,012
Net plan assets at end of year (total assets less liabilities)2010-12-31$140,739
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$181,751
Total contributions received or receivable from employer(s)2010-12-31$604,019
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$47,194

Form 5500 Responses for BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST

2023: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2017: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 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 – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VERITY HEALTHNET (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 Covered50
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,158
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $4,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PPO PLUS (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 Covered50
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,921
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $7,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VERITY HEALTHNET (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 Covered54
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,290
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $5,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PPO PLUS (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 Covered54
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,613
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $7,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered54
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $721
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedDEP. LIFE
Welfare Benefit Premiums Paid to CarrierUSD $3,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 5
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 6
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 1
PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 2

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