HARDWARE DISTRIBUTION WAREHOUSES, INC. has sponsored the creation of one or more 401k plans.
Additional information about HARDWARE DISTRIBUTION WAREHOUSES, INC.
Submission information for form 5500 for 401k plan HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST
401k plan membership statisitcs for HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST
| Measure | Date | Value |
|---|
| 2018: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 161 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 112 |
| Total of all active and inactive participants | 2018-10-01 | 112 |
| 2017: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 161 |
| Total of all active and inactive participants | 2017-10-01 | 161 |
| 2016: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 98 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 198 |
| Total of all active and inactive participants | 2016-10-01 | 198 |
| 2015: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 91 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 98 |
| Total of all active and inactive participants | 2015-10-01 | 98 |
| 2014: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 91 |
| Total of all active and inactive participants | 2014-10-01 | 91 |
| 2013: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 94 |
| Total of all active and inactive participants | 2013-10-01 | 94 |
| 2012: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 85 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 88 |
| Total of all active and inactive participants | 2012-10-01 | 88 |
| 2011: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 85 |
| Total of all active and inactive participants | 2011-10-01 | 85 |
| 2009: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 87 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 77 |
| Total of all active and inactive participants | 2009-10-01 | 77 |
| Measure | Date | Value |
|---|
| 2018 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-09-30 | $219,893 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-09-30 | $0 |
| Total income from all sources (including contributions) | 2018-09-30 | $2,985,895 |
| Total of all expenses incurred | 2018-09-30 | $2,941,386 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-09-30 | $2,873,306 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-09-30 | $2,661,501 |
| Value of total assets at end of year | 2018-09-30 | $268,227 |
| Value of total assets at beginning of year | 2018-09-30 | $3,825 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-09-30 | $68,080 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-09-30 | No |
| Was this plan covered by a fidelity bond | 2018-09-30 | Yes |
| Value of fidelity bond cover | 2018-09-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-09-30 | No |
| Contributions received from participants | 2018-09-30 | $568,298 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-09-30 | $268,227 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-09-30 | $177,347 |
| Other income not declared elsewhere | 2018-09-30 | $324,394 |
| Administrative expenses (other) incurred | 2018-09-30 | $68,080 |
| Total non interest bearing cash at end of year | 2018-09-30 | $0 |
| Total non interest bearing cash at beginning of year | 2018-09-30 | $3,825 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
| Value of net income/loss | 2018-09-30 | $44,509 |
| Value of net assets at end of year (total assets less liabilities) | 2018-09-30 | $48,334 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-09-30 | $3,825 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-09-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-09-30 | $622,682 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-09-30 | No |
| Contributions received in cash from employer | 2018-09-30 | $2,093,203 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-09-30 | $2,250,624 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-09-30 | $42,546 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-09-30 | $0 |
| Did the plan have assets held for investment | 2018-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-09-30 | Unqualified |
| Accountancy firm name | 2018-09-30 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2018-09-30 | 721447940 |
| 2017 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 401k financial data |
|---|
| Total income from all sources | 2017-09-30 | $2,610,795 |
| Expenses. Total of all expenses incurred | 2017-09-30 | $2,607,639 |
| Benefits paid (including direct rollovers) | 2017-09-30 | $2,534,417 |
| Total plan assets at end of year | 2017-09-30 | $3,825 |
| Total plan assets at beginning of year | 2017-09-30 | $669 |
| Total contributions received or receivable from participants | 2017-09-30 | $382,359 |
| Expenses. Other expenses not covered elsewhere | 2017-09-30 | $73,222 |
| Other income received | 2017-09-30 | $240,099 |
| Net income (gross income less expenses) | 2017-09-30 | $3,156 |
| Net plan assets at end of year (total assets less liabilities) | 2017-09-30 | $3,825 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-09-30 | $669 |
| Total contributions received or receivable from employer(s) | 2017-09-30 | $1,988,337 |
| 2016 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 401k financial data |
|---|
| Total income from all sources | 2016-09-30 | $1,371,109 |
| Expenses. Total of all expenses incurred | 2016-09-30 | $1,370,541 |
| Benefits paid (including direct rollovers) | 2016-09-30 | $1,328,309 |
| Total plan assets at end of year | 2016-09-30 | $669 |
| Total plan assets at beginning of year | 2016-09-30 | $101 |
| Total contributions received or receivable from participants | 2016-09-30 | $216,676 |
| Expenses. Other expenses not covered elsewhere | 2016-09-30 | $42,232 |
| Other income received | 2016-09-30 | $20,435 |
| Net income (gross income less expenses) | 2016-09-30 | $568 |
| Net plan assets at end of year (total assets less liabilities) | 2016-09-30 | $669 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-09-30 | $101 |
| Total contributions received or receivable from employer(s) | 2016-09-30 | $1,133,998 |
| 2015 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 401k financial data |
|---|
| Total income from all sources | 2015-09-30 | $939,960 |
| Expenses. Total of all expenses incurred | 2015-09-30 | $940,019 |
| Benefits paid (including direct rollovers) | 2015-09-30 | $897,873 |
| Total plan assets at end of year | 2015-09-30 | $101 |
| Total plan assets at beginning of year | 2015-09-30 | $160 |
| Total contributions received or receivable from participants | 2015-09-30 | $192,452 |
| Expenses. Other expenses not covered elsewhere | 2015-09-30 | $42,146 |
| Other income received | 2015-09-30 | $18,637 |
| Net income (gross income less expenses) | 2015-09-30 | $-59 |
| Net plan assets at end of year (total assets less liabilities) | 2015-09-30 | $101 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-09-30 | $160 |
| Total contributions received or receivable from employer(s) | 2015-09-30 | $728,871 |
| 2014 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 401k financial data |
|---|
| Total income from all sources | 2014-09-30 | $994,480 |
| Expenses. Total of all expenses incurred | 2014-09-30 | $994,520 |
| Benefits paid (including direct rollovers) | 2014-09-30 | $953,386 |
| Total plan assets at end of year | 2014-09-30 | $160 |
| Total plan assets at beginning of year | 2014-09-30 | $200 |
| Total contributions received or receivable from participants | 2014-09-30 | $177,455 |
| Expenses. Other expenses not covered elsewhere | 2014-09-30 | $41,134 |
| Other income received | 2014-09-30 | $28,471 |
| Net income (gross income less expenses) | 2014-09-30 | $-40 |
| Net plan assets at end of year (total assets less liabilities) | 2014-09-30 | $160 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-09-30 | $200 |
| Total contributions received or receivable from employer(s) | 2014-09-30 | $788,554 |
| 2013 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 401k financial data |
|---|
| Total income from all sources | 2013-09-30 | $1,177,801 |
| Expenses. Total of all expenses incurred | 2013-09-30 | $1,178,615 |
| Benefits paid (including direct rollovers) | 2013-09-30 | $1,145,524 |
| Total plan assets at end of year | 2013-09-30 | $200 |
| Total plan assets at beginning of year | 2013-09-30 | $1,014 |
| Total contributions received or receivable from participants | 2013-09-30 | $139,988 |
| Expenses. Other expenses not covered elsewhere | 2013-09-30 | $33,091 |
| Net income (gross income less expenses) | 2013-09-30 | $-814 |
| Net plan assets at end of year (total assets less liabilities) | 2013-09-30 | $200 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-09-30 | $1,014 |
| Total contributions received or receivable from employer(s) | 2013-09-30 | $1,037,813 |
| 2012 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 401k financial data |
|---|
| Total income from all sources | 2012-09-30 | $864,826 |
| Expenses. Total of all expenses incurred | 2012-09-30 | $864,036 |
| Benefits paid (including direct rollovers) | 2012-09-30 | $818,407 |
| Total plan assets at end of year | 2012-09-30 | $1,014 |
| Total plan assets at beginning of year | 2012-09-30 | $224 |
| Total contributions received or receivable from participants | 2012-09-30 | $129,779 |
| Net income (gross income less expenses) | 2012-09-30 | $790 |
| Net plan assets at end of year (total assets less liabilities) | 2012-09-30 | $1,014 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-09-30 | $224 |
| Total contributions received or receivable from employer(s) | 2012-09-30 | $735,047 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-09-30 | $45,629 |
| 2011 : HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 401k financial data |
|---|
| Total income from all sources | 2011-09-30 | $805,085 |
| Expenses. Total of all expenses incurred | 2011-09-30 | $806,964 |
| Benefits paid (including direct rollovers) | 2011-09-30 | $765,726 |
| Total plan assets at end of year | 2011-09-30 | $224 |
| Total plan assets at beginning of year | 2011-09-30 | $2,103 |
| Total contributions received or receivable from participants | 2011-09-30 | $129,054 |
| Other income received | 2011-09-30 | $16,217 |
| Net income (gross income less expenses) | 2011-09-30 | $-1,879 |
| Net plan assets at end of year (total assets less liabilities) | 2011-09-30 | $224 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-09-30 | $2,103 |
| Total contributions received or receivable from employer(s) | 2011-09-30 | $659,814 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-09-30 | $41,238 |
| 2018: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – Trust | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement - Trust | Yes |
| 2016: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – Trust | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement - Trust | Yes |
| 2015: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – Trust | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement - Trust | Yes |
| 2014: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – Trust | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement - Trust | Yes |
| 2013: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – Trust | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement - Trust | Yes |
| 2012: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – Trust | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement - Trust | Yes |
| 2011: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – Trust | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement - Trust | Yes |
| 2009: HARDWARE DISTRIBUTION WAREHOUSES, INC. EMPLOYEE BENEFIT PLAN AND TRUST 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan funding arrangement – Trust | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement - Trust | Yes |
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 8 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $9,957 | | Total amount of fees paid to insurance company | USD $21,856 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,957 | | Amount paid for insurance broker fees | 21856 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | 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 | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $3,552 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $43,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,552 | | 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 | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $849 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $2,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $849 | | Insurance broker organization code? | 5 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,741 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | INDIVIDUAL PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $14,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,741 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $522 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $2,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $522 | | Insurance broker organization code? | 5 |
|
| AMERICAN HEALTH HOLDINGS (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 | 112 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $637 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $3,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $637 | | 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 | 10 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $17,719 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,856 | | 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 number | NOT AVAILABLE |
| Policy instance | 8 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $6,557 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $17,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 208 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,078 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $13,488 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | INDIVIDUAL PRODUCTS | | Welfare Benefit Premiums Paid to Carrier | USD $44,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVALIABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVALIABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,968 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $7,806 | | 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 AVALIABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVALIABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,185 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | NOT AVALIABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVALIABLE | | Number of Individuals Covered | 161 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $50,186 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $334,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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