BILL & RALPH'S, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan 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 |
|---|
| 2022: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 54 |
| Total of all active and inactive participants | 2022-01-01 | 54 |
| 2021: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 61 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 55 |
| Total of all active and inactive participants | 2021-01-01 | 55 |
| 2020: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 61 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 61 |
| Total of all active and inactive participants | 2020-01-01 | 61 |
| 2019: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 65 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 61 |
| Total of all active and inactive participants | 2019-01-01 | 61 |
| 2018: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 65 |
| Total of all active and inactive participants | 2018-01-01 | 65 |
| 2017: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 68 |
| Total of all active and inactive participants | 2017-01-01 | 68 |
| 2016: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 73 |
| Total of all active and inactive participants | 2016-01-01 | 73 |
| 2015: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 75 |
| Total of all active and inactive participants | 2015-01-01 | 75 |
| 2014: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 70 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 66 |
| Total of all active and inactive participants | 2014-01-01 | 66 |
| 2013: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 70 |
| Total of all active and inactive participants | 2013-01-01 | 70 |
| 2012: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 82 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 79 |
| Total of all active and inactive participants | 2012-01-01 | 79 |
| 2011: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 85 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 82 |
| Total of all active and inactive participants | 2011-01-01 | 82 |
| 2010: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 85 |
| Total of all active and inactive participants | 2010-01-01 | 85 |
| 2009: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 78 |
| Total of all active and inactive participants | 2009-01-01 | 78 |
| Measure | Date | Value |
|---|
| 2022 : BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $597,735 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $533,378 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $511,430 |
| Total plan assets at end of year | 2022-12-31 | $66,859 |
| Total plan assets at beginning of year | 2022-12-31 | $2,502 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $21,948 |
| Other income received | 2022-12-31 | $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 sources | 2021-12-31 | $881,488 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $942,540 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $919,882 |
| Total plan assets at end of year | 2021-12-31 | $2,502 |
| Total plan assets at beginning of year | 2021-12-31 | $63,554 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $22,658 |
| Other income received | 2021-12-31 | $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 sources | 2020-12-31 | $840,827 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $826,077 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $778,218 |
| Total plan assets at end of year | 2020-12-31 | $63,554 |
| Total plan assets at beginning of year | 2020-12-31 | $48,804 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $47,859 |
| Other income received | 2020-12-31 | $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 sources | 2019-12-31 | $890,934 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $849,538 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $826,490 |
| Total plan assets at end of year | 2019-12-31 | $48,804 |
| Total plan assets at beginning of year | 2019-12-31 | $7,408 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $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 sources | 2018-12-31 | $795,394 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $792,300 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $763,766 |
| Total plan assets at end of year | 2018-12-31 | $7,408 |
| Total plan assets at beginning of year | 2018-12-31 | $4,314 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $28,534 |
| Other income received | 2018-12-31 | $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 sources | 2017-12-31 | $909,690 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $921,015 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $889,502 |
| Total plan assets at end of year | 2017-12-31 | $4,314 |
| Total plan assets at beginning of year | 2017-12-31 | $15,639 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $31,513 |
| Other income received | 2017-12-31 | $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 sources | 2016-12-31 | $799,306 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $948,340 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $912,174 |
| Total plan assets at end of year | 2016-12-31 | $15,639 |
| Total plan assets at beginning of year | 2016-12-31 | $164,673 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $36,166 |
| Other income received | 2016-12-31 | $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 sources | 2015-12-31 | $931,515 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,047,131 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,007,563 |
| Total plan assets at end of year | 2015-12-31 | $164,673 |
| Total plan assets at beginning of year | 2015-12-31 | $280,289 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $39,568 |
| Other income received | 2015-12-31 | $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 sources | 2014-12-31 | $687,858 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $596,837 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $557,950 |
| Total plan assets at end of year | 2014-12-31 | $280,289 |
| Total plan assets at beginning of year | 2014-12-31 | $189,268 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $38,887 |
| Other income received | 2014-12-31 | $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 sources | 2013-12-31 | $704,178 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $719,860 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $682,337 |
| Total plan assets at end of year | 2013-12-31 | $189,268 |
| Total plan assets at beginning of year | 2013-12-31 | $204,950 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $37,523 |
| Other income received | 2013-12-31 | $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 sources | 2012-12-31 | $1,088,631 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $1,129,629 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $1,078,884 |
| Total plan assets at end of year | 2012-12-31 | $204,950 |
| Total plan assets at beginning of year | 2012-12-31 | $245,948 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $50,745 |
| Other income received | 2012-12-31 | $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 sources | 2011-12-31 | $870,623 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $765,414 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $717,974 |
| Total plan assets at end of year | 2011-12-31 | $245,948 |
| Total plan assets at beginning of year | 2011-12-31 | $140,739 |
| Other income received | 2011-12-31 | $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 sources | 2010-12-31 | $727,075 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $768,087 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $720,893 |
| Total plan assets at end of year | 2010-12-31 | $140,739 |
| Total plan assets at beginning of year | 2010-12-31 | $181,751 |
| Other income received | 2010-12-31 | $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 |
| 2022: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: BILL & RALPH'S, INC. EMPLOYEES BENEFIT PLAN AND TRUST 2009 form 5500 responses |
|---|
| 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 – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,290 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,290 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,613 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,613 | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $721 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $3,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $721 | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $802 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $4,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $802 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,416 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,956 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,416 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $35,815 | | Total amount of fees paid to insurance company | USD $19,217 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $235,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,815 | | Amount paid for insurance broker fees | 19217 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,770 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,770 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $39,060 | | Total amount of fees paid to insurance company | USD $20,835 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $257,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,060 | | Amount paid for insurance broker fees | 20835 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,538 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,538 | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $877 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $4,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $877 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,923 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,768 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,923 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,950 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,950 | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $872 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $4,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $872 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $53,100 | | Total amount of fees paid to insurance company | USD $19,587 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $350,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,100 | | Amount paid for insurance broker fees | 19569 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,560 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,240 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,560 | | Insurance broker organization code? | 5 |
|
| AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,187 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,187 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $57,454 | | Total amount of fees paid to insurance company | USD $24,589 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $387,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,454 | | Amount paid for insurance broker fees | 19843 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,582 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,582 | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $864 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $4,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $864 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,978 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,978 | | Insurance broker organization code? | 5 |
|
| AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $482 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $482 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $998 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $4,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $998 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $878 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $878 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $57,647 | | Total amount of fees paid to insurance company | USD $27,209 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $380,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,647 | | Amount paid for insurance broker fees | 21947 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $440 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $440 | | Insurance broker name | IMA, INC. |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $48,963 | | Total amount of fees paid to insurance company | USD $31,674 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $322,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,963 | | Amount paid for insurance broker fees | 26394 | | Additional information about fees paid to insurance broker | THIRD PARTY FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $880 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $880 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,022 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DEP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $5,111 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,022 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $45,759 | | Total amount of fees paid to insurance company | USD $29,535 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $301,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,759 | | Amount paid for insurance broker fees | 24621 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $819 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $819 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $237 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $1,140 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $237 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $936 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D AND D | | Welfare Benefit Premiums Paid to Carrier | USD $4,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $936 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 66 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $410 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $410 | | Insurance broker name | IMA, INC. |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 70 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $871 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $871 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 70 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,009 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D AND D | | Welfare Benefit Premiums Paid to Carrier | USD $5,042 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,009 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 70 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $479 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $479 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 70 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $42,330 | | Total amount of fees paid to insurance company | USD $31,329 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $278,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,330 | | Amount paid for insurance broker fees | 26103 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 79 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $124 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $124 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 79 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,009 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,009 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 79 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $45,258 | | Total amount of fees paid to insurance company | USD $39,281 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $297,582 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,258 | | Amount paid for insurance broker fees | 33227 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 79 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,164 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D AND D | | Welfare Benefit Premiums Paid to Carrier | USD $5,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,164 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 82 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $36,588 | | Total amount of fees paid to insurance company | USD $37,073 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $239,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 82 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,143 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D AND D | | Welfare Benefit Premiums Paid to Carrier | USD $5,717 | | 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 number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 82 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $544 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,621 | | 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 number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 82 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $989 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,192 | | 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 number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 85 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,173 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D AND D | | Welfare Benefit Premiums Paid to Carrier | USD $5,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,173 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 85 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $993 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $993 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 85 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $28,004 | | Total amount of fees paid to insurance company | USD $35,329 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $182,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,004 | | Amount paid for insurance broker fees | 29371 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | | Insurance broker organization code? | 5 | | Insurance broker name | GR FINANCIAL DESIGN, INC. |
|
| IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 85 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $546 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $546 | | Insurance broker organization code? | 5 | | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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