SUPERIOR PERFORMANCE, INC. has sponsored the creation of one or more 401k plans.
Additional information about SUPERIOR PERFORMANCE, INC.
Submission information for form 5500 for 401k plan SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST
401k plan membership statisitcs for SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST
| Measure | Date | Value |
|---|
| 2022 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $31,329 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $349,988 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $325,996 |
| Total plan assets at end of year | 2022-12-31 | $12,673 |
| Total plan assets at beginning of year | 2022-12-31 | $331,332 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $3,889 |
| Other income received | 2022-12-31 | $7,445 |
| Net income (gross income less expenses) | 2022-12-31 | $-318,659 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $12,673 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $331,332 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $23,884 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $20,103 |
| 2021 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $1,116,023 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,370,260 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $1,335,490 |
| Total plan assets at end of year | 2021-12-31 | $331,332 |
| Total plan assets at beginning of year | 2021-12-31 | $585,569 |
| Total contributions received or receivable from participants | 2021-12-31 | $579,859 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $2,302 |
| Other income received | 2021-12-31 | $171,994 |
| Net income (gross income less expenses) | 2021-12-31 | $-254,237 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $331,332 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $585,569 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $364,170 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $32,468 |
| 2020 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $1,084,597 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $869,243 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $832,403 |
| Total plan assets at end of year | 2020-12-31 | $585,569 |
| Total plan assets at beginning of year | 2020-12-31 | $370,215 |
| Total contributions received or receivable from participants | 2020-12-31 | $723,295 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $4,931 |
| Net income (gross income less expenses) | 2020-12-31 | $215,354 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $585,569 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $370,215 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $361,302 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $31,909 |
| 2019 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $1,197,869 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $1,216,521 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $1,177,528 |
| Total plan assets at end of year | 2019-12-31 | $370,215 |
| Total plan assets at beginning of year | 2019-12-31 | $388,867 |
| Total contributions received or receivable from participants | 2019-12-31 | $778,215 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $4,641 |
| Other income received | 2019-12-31 | $15,728 |
| Net income (gross income less expenses) | 2019-12-31 | $-18,652 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $370,215 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $388,867 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $403,926 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $34,352 |
| 2018 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $1,302,872 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,061,642 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $1,024,907 |
| Total plan assets at end of year | 2018-12-31 | $388,867 |
| Total plan assets at beginning of year | 2018-12-31 | $147,637 |
| Total contributions received or receivable from participants | 2018-12-31 | $908,328 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $5,167 |
| Net income (gross income less expenses) | 2018-12-31 | $241,230 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $388,867 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $147,637 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $394,544 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $31,568 |
| 2017 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $13,443 |
| Total income from all sources | 2017-12-31 | $969,645 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,102,620 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $1,068,818 |
| Total plan assets at end of year | 2017-12-31 | $147,637 |
| Total plan assets at beginning of year | 2017-12-31 | $294,055 |
| Total contributions received or receivable from participants | 2017-12-31 | $524,657 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $5,099 |
| Net income (gross income less expenses) | 2017-12-31 | $-132,975 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $147,637 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $280,612 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $444,988 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $28,703 |
| 2016 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $13,443 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $43,540 |
| Total income from all sources (including contributions) | 2016-12-31 | $1,297,582 |
| Total of all expenses incurred | 2016-12-31 | $1,280,520 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $1,239,259 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $1,297,582 |
| Value of total assets at end of year | 2016-12-31 | $294,055 |
| Value of total assets at beginning of year | 2016-12-31 | $307,090 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $41,261 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $647,917 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $95,412 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $235,276 |
| Administrative expenses (other) incurred | 2016-12-31 | $8,142 |
| Total non interest bearing cash at end of year | 2016-12-31 | $198,643 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $71,814 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $17,062 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $280,612 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $263,550 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $463,335 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $649,665 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $775,924 |
| Contract administrator fees | 2016-12-31 | $33,119 |
| 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 | 2016-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $13,443 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $43,540 |
| Did the plan have assets held for investment | 2016-12-31 | 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 | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2016-12-31 | 721447940 |
| 2015 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $43,540 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $93,449 |
| Total income from all sources (including contributions) | 2015-12-31 | $1,781,106 |
| Total of all expenses incurred | 2015-12-31 | $1,517,556 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $1,472,818 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $1,544,608 |
| Value of total assets at end of year | 2015-12-31 | $307,090 |
| Value of total assets at beginning of year | 2015-12-31 | $93,449 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $44,738 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $547,469 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $235,276 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $79,806 |
| Other income not declared elsewhere | 2015-12-31 | $236,498 |
| Administrative expenses (other) incurred | 2015-12-31 | $5,787 |
| Total non interest bearing cash at end of year | 2015-12-31 | $71,814 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $13,643 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $263,550 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $263,550 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $464,468 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $997,139 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $1,008,350 |
| Contract administrator fees | 2015-12-31 | $38,951 |
| 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 | 2015-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $43,540 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $93,449 |
| Did the plan have assets held for investment | 2015-12-31 | 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 | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2015-12-31 | 721447940 |
| 2014 : SUPERIOR PERFORMANCE, INC EMPLOYEE BENEFIT PLAN & TRUST 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $1,162,872 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,119,229 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,063,570 |
| Total plan assets at end of year | 2014-12-31 | $43,643 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $55,659 |
| Other income received | 2014-12-31 | $42,606 |
| Net income (gross income less expenses) | 2014-12-31 | $43,643 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $43,643 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,120,266 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 9 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,151 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,151 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $968 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $968 | | 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 | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $968 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,808 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $968 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (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 | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $968 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $968 | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,445 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D SUPP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $46,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,445 | | Insurance broker organization code? | 5 |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 57 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $712 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $712 | | Insurance broker organization code? | 5 |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $922 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $922 | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,143 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D SUPP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $40,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,143 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (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 | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,022 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $9,198 | | 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 |
|
| 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 | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $511 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $511 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,533 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,533 | | 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 | 9 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 77 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,857 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,857 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,504 | | 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 | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,342 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,026 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,342 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (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 | 92 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,171 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,026 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,171 | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,092 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D SUPP. LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $41,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,092 | | Insurance broker organization code? | 5 |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,055 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,480 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,055 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 7 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MULTIPLAN (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 | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,628 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,628 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (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 | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,085 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,510 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,085 | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,418 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,418 | | Insurance broker organization code? | 5 |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $834 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $834 | | Insurance broker organization code? | 5 |
|
| AMERICAN HEALTH HOLDINGS (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 | 94 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,671 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $4,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,671 | | Insurance broker organization code? | 5 |
|
| AMERICAN HEALTH HOLDINGS (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 | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $570 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $3,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $570 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $36,320 | | Total amount of fees paid to insurance company | USD $28,703 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $242,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,320 | | Amount paid for insurance broker fees | 28703 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $796 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $796 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,193 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,193 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,433 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,433 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| AMERICAN HEALTH HOLDINGS (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 | 120 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $777 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | PRECERTIFICATION | | Welfare Benefit Premiums Paid to Carrier | USD $4,098 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $777 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $43,686 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $303,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,686 | | 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 | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,413 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $12,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,413 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $962 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $962 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 6 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 120 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,479 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,479 | | 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 | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,197 | | 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 $10,175 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,197 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $42,598 | | Total amount of fees paid to insurance company | USD $35,216 | | 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 $284,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,598 | | Amount paid for insurance broker fees | 35216 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | 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 | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $311 | | 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 $1,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $311 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
|
| IHEALTH (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 | 109 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $848 | | 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 | HEALTH BENEFIT MANAGEMENT SERVICES | | Welfare Benefit Premiums Paid to Carrier | USD $3,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $848 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC |
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