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BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 401k Plan overview

Plan NameBAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST
Plan identification number 501

BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST Benefits

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

401k Sponsoring company profile

BAYOU CHATEAU NURSING CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:BAYOU CHATEAU NURSING CENTER, INC.
Employer identification number (EIN):720768016
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01GERARD LACOUR
5012016-01-01GERARD LACOUR

Plan Statistics for BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST

401k plan membership statisitcs for BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST

Measure Date Value
2022: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-0149
Total number of active participants reported on line 7a of the Form 55002022-01-0148
Total of all active and inactive participants2022-01-0148
2021: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-0150
Total number of active participants reported on line 7a of the Form 55002021-01-0149
Total of all active and inactive participants2021-01-0149
2020: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-0155
Total number of active participants reported on line 7a of the Form 55002020-01-0150
Total of all active and inactive participants2020-01-0150
2019: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-0154
Total number of active participants reported on line 7a of the Form 55002019-01-0155
Total of all active and inactive participants2019-01-0155
2018: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-0156
Total number of active participants reported on line 7a of the Form 55002018-01-0154
Total of all active and inactive participants2018-01-0154
2017: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0157
Total number of active participants reported on line 7a of the Form 55002017-01-0156
Total of all active and inactive participants2017-01-0156
2016: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0195
Total number of active participants reported on line 7a of the Form 55002016-01-0157
Total of all active and inactive participants2016-01-0157

Financial Data on BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST

Measure Date Value
2022 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2022 401k financial data
Total income from all sources2022-12-31$485,083
Expenses. Total of all expenses incurred2022-12-31$438,859
Benefits paid (including direct rollovers)2022-12-31$405,850
Total plan assets at end of year2022-12-31$124,109
Total plan assets at beginning of year2022-12-31$77,885
Expenses. Other expenses not covered elsewhere2022-12-31$33,009
Other income received2022-12-31$15,197
Net income (gross income less expenses)2022-12-31$46,224
Net plan assets at end of year (total assets less liabilities)2022-12-31$124,109
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$77,885
Total contributions received or receivable from employer(s)2022-12-31$469,886
2021 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2021 401k financial data
Total income from all sources2021-12-31$485,546
Expenses. Total of all expenses incurred2021-12-31$416,702
Benefits paid (including direct rollovers)2021-12-31$382,593
Total plan assets at end of year2021-12-31$77,885
Total plan assets at beginning of year2021-12-31$9,041
Expenses. Other expenses not covered elsewhere2021-12-31$34,109
Net income (gross income less expenses)2021-12-31$68,844
Net plan assets at end of year (total assets less liabilities)2021-12-31$77,885
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$9,041
Total contributions received or receivable from employer(s)2021-12-31$485,546
2020 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2020 401k financial data
Total income from all sources2020-12-31$740,242
Expenses. Total of all expenses incurred2020-12-31$773,396
Benefits paid (including direct rollovers)2020-12-31$736,957
Total plan assets at end of year2020-12-31$9,041
Total plan assets at beginning of year2020-12-31$42,195
Expenses. Other expenses not covered elsewhere2020-12-31$36,439
Other income received2020-12-31$268,437
Net income (gross income less expenses)2020-12-31$-33,154
Net plan assets at end of year (total assets less liabilities)2020-12-31$9,041
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$42,195
Total contributions received or receivable from employer(s)2020-12-31$471,805
2019 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2019 401k financial data
Total income from all sources2019-12-31$893,318
Expenses. Total of all expenses incurred2019-12-31$955,863
Benefits paid (including direct rollovers)2019-12-31$921,634
Total plan assets at end of year2019-12-31$42,195
Total plan assets at beginning of year2019-12-31$104,740
Expenses. Other expenses not covered elsewhere2019-12-31$34,229
Other income received2019-12-31$531,965
Net income (gross income less expenses)2019-12-31$-62,545
Net plan assets at end of year (total assets less liabilities)2019-12-31$42,195
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$104,740
Total contributions received or receivable from employer(s)2019-12-31$361,353
2018 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2018 401k financial data
Total income from all sources2018-12-31$456,741
Expenses. Total of all expenses incurred2018-12-31$493,192
Benefits paid (including direct rollovers)2018-12-31$448,898
Total plan assets at end of year2018-12-31$104,740
Total plan assets at beginning of year2018-12-31$141,191
Expenses. Other expenses not covered elsewhere2018-12-31$44,294
Other income received2018-12-31$48,579
Net income (gross income less expenses)2018-12-31$-36,451
Net plan assets at end of year (total assets less liabilities)2018-12-31$104,740
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$141,191
Total contributions received or receivable from employer(s)2018-12-31$408,162
2017 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2017 401k financial data
Total income from all sources2017-12-31$365,707
Expenses. Total of all expenses incurred2017-12-31$297,844
Benefits paid (including direct rollovers)2017-12-31$251,193
Total plan assets at end of year2017-12-31$141,191
Total plan assets at beginning of year2017-12-31$73,328
Expenses. Other expenses not covered elsewhere2017-12-31$46,651
Net income (gross income less expenses)2017-12-31$67,863
Net plan assets at end of year (total assets less liabilities)2017-12-31$141,191
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$73,328
Total contributions received or receivable from employer(s)2017-12-31$365,707
2016 : BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2016 401k financial data
Total income from all sources2016-12-31$451,329
Expenses. Total of all expenses incurred2016-12-31$378,001
Benefits paid (including direct rollovers)2016-12-31$322,753
Total plan assets at end of year2016-12-31$73,328
Total plan assets at beginning of year2016-12-31$0
Expenses. Other expenses not covered elsewhere2016-12-31$55,248
Net income (gross income less expenses)2016-12-31$73,328
Net plan assets at end of year (total assets less liabilities)2016-12-31$73,328
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$451,329

Form 5500 Responses for BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST

2022: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BAYOU CHATEAU NURSING CENTER, INC. EMPLOYEE BENEFIT PLAN & TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered48
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $577
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $6,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $577
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered48
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,144
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $12,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,144
Insurance broker organization code?5
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered49
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $612
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $5,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $612
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered49
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,093
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $13,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,093
Insurance broker organization code?5
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered50
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $667
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $6,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $667
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered50
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,310
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $13,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,310
Insurance broker organization code?5
VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered55
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $682
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $6,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $682
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered55
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,933
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $11,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,933
Insurance broker organization code?5
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered55
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $18,945
Total amount of fees paid to insurance companyUSD $28,344
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $123,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,945
Amount paid for insurance broker fees28344
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered54
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,942
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $11,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,942
Insurance broker organization code?5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered54
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $575
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $575
Insurance broker organization code?5
AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered54
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,083
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,083
Insurance broker organization code?5
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered54
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $19,649
Total amount of fees paid to insurance companyUSD $37,129
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $128,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,649
Amount paid for insurance broker fees25996
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberNOT AVAILABLE
Policy instance 5
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered56
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,963
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $11,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,963
Insurance broker organization code?5
Insurance broker nameIMA, INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberNOT AVAILABLE
Policy instance 4
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered56
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $616
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $616
Insurance broker organization code?5
Insurance broker nameIMA, INC
AMERICAN HEALTH HOLDINGS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 3
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered56
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $381
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedPRECERTIFICATION
Welfare Benefit Premiums Paid to CarrierUSD $2,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $381
Insurance broker organization code?5
Insurance broker nameIMA, INC
PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberNOT AVAILABLE
Policy instance 1
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered56
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $19,920
Total amount of fees paid to insurance companyUSD $36,879
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOMPLIANCE
Welfare Benefit Premiums Paid to CarrierUSD $129,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,920
Amount paid for insurance broker fees24850
Additional information about fees paid to insurance brokerTHIRD PARTY ADMIN FEES
Insurance broker organization code?5
Insurance broker nameIMSA

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