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FABRICUT, INC. HEALTH PLAN 401k Plan overview

Plan NameFABRICUT, INC. HEALTH PLAN
Plan identification number 502

FABRICUT, INC. HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Supplemental unemployment
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

FABRICUT, INC. has sponsored the creation of one or more 401k plans.

Company Name:FABRICUT, INC.
Employer identification number (EIN):730619725
NAIC Classification:424300

Additional information about FABRICUT, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2000-10-25
Company Identification Number: 0013529506
Legal Registered Office Address: PO BOX 470490 ATTN: CHERIE WILSON

TULSA
United States of America (USA)
74147

More information about FABRICUT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FABRICUT, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-10-01RON GRAHAM2023-06-30
5022020-10-01RON GRAHAM2022-07-12
5022019-10-01
5022018-10-01KAITLIN E. FLINN, CPA2020-07-15
5022017-10-01
5022016-10-01RON GRAHAM
5022015-10-01RON GRAHAM
5022014-10-01RON GRAHAM
5022013-10-01RON GRAHAM
5022012-10-01RON GRAHAM
5022011-10-01RON GRAHAM
5022011-07-01RON GRAHAM
5022009-07-01MICHELE SMITH
5022009-07-01MICHELE K. SMITH, CPA

Plan Statistics for FABRICUT, INC. HEALTH PLAN

401k plan membership statisitcs for FABRICUT, INC. HEALTH PLAN

Measure Date Value
2021: FABRICUT, INC. HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01370
Total number of active participants reported on line 7a of the Form 55002021-10-01387
Number of retired or separated participants receiving benefits2021-10-012
Total of all active and inactive participants2021-10-01389
2020: FABRICUT, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01350
Total number of active participants reported on line 7a of the Form 55002020-10-01370
Number of retired or separated participants receiving benefits2020-10-018
Total of all active and inactive participants2020-10-01378
2019: FABRICUT, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01391
Total number of active participants reported on line 7a of the Form 55002019-10-01350
Number of retired or separated participants receiving benefits2019-10-012
Total of all active and inactive participants2019-10-01352
2018: FABRICUT, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01393
Total number of active participants reported on line 7a of the Form 55002018-10-01391
Number of retired or separated participants receiving benefits2018-10-013
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01394
2017: FABRICUT, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01375
Total number of active participants reported on line 7a of the Form 55002017-10-01391
Number of retired or separated participants receiving benefits2017-10-012
Total of all active and inactive participants2017-10-01393
Total participants2017-10-01393
2016: FABRICUT, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01381
Total number of active participants reported on line 7a of the Form 55002016-10-01374
Number of retired or separated participants receiving benefits2016-10-011
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01375
2015: FABRICUT, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01383
Total number of active participants reported on line 7a of the Form 55002015-10-01378
Number of retired or separated participants receiving benefits2015-10-013
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01381
2014: FABRICUT, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01362
Total number of active participants reported on line 7a of the Form 55002014-10-01380
Number of retired or separated participants receiving benefits2014-10-013
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01383
2013: FABRICUT, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01339
Total number of active participants reported on line 7a of the Form 55002013-10-01328
Number of retired or separated participants receiving benefits2013-10-016
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01334
2012: FABRICUT, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01358
Total number of active participants reported on line 7a of the Form 55002012-10-01347
Number of retired or separated participants receiving benefits2012-10-015
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01352
2011: FABRICUT, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01362
Total number of active participants reported on line 7a of the Form 55002011-10-01359
Number of retired or separated participants receiving benefits2011-10-017
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01366
Total participants, beginning-of-year2011-07-01342
Total number of active participants reported on line 7a of the Form 55002011-07-01344
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01344
2009: FABRICUT, INC. HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01336
Total number of active participants reported on line 7a of the Form 55002009-07-01318
Total of all active and inactive participants2009-07-01318

Financial Data on FABRICUT, INC. HEALTH PLAN

Measure Date Value
2022 : FABRICUT, INC. HEALTH PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$554,721
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$557,129
Total income from all sources (including contributions)2022-09-30$4,799,621
Total of all expenses incurred2022-09-30$4,782,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-09-30$4,572,133
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-09-30$4,799,621
Value of total assets at end of year2022-09-30$3,271,430
Value of total assets at beginning of year2022-09-30$3,256,989
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-09-30$210,639
Total interest from all sources2022-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-09-30No
Administrative expenses professional fees incurred2022-09-30$210,639
Was this plan covered by a fidelity bond2022-09-30Yes
Value of fidelity bond cover2022-09-30$500,000
If this is an individual account plan, was there a blackout period2022-09-30No
Were there any nonexempt tranactions with any party-in-interest2022-09-30No
Contributions received from participants2022-09-30$1,526,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Value of net income/loss2022-09-30$16,849
Value of net assets at end of year (total assets less liabilities)2022-09-30$2,716,709
Value of net assets at beginning of year (total assets less liabilities)2022-09-30$2,699,860
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-09-30No
Were any leases to which the plan was party in default or uncollectible2022-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-09-30$3,271,430
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-09-30$3,256,989
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-09-30$3,256,989
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-09-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-09-30$1,121,558
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-09-30No
Was there a failure to transmit to the plan any participant contributions2022-09-30No
Has the plan failed to provide any benefit when due under the plan2022-09-30No
Contributions received in cash from employer2022-09-30$3,273,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-09-30$3,450,575
Contract administrator fees2022-09-30$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-09-30No
Liabilities. Value of benefit claims payable at end of year2022-09-30$554,721
Liabilities. Value of benefit claims payable at beginning of year2022-09-30$557,129
Did the plan have assets held for investment2022-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-09-30No
Opinion of an independent qualified public accountant for this plan2022-09-30Unqualified
Accountancy firm name2022-09-30CCK STRATEGIES
Accountancy firm EIN2022-09-30731528194
2021 : FABRICUT, INC. HEALTH PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$557,129
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$569,478
Total income from all sources (including contributions)2021-09-30$4,840,065
Total of all expenses incurred2021-09-30$4,785,761
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$4,542,448
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$4,840,053
Value of total assets at end of year2021-09-30$3,256,989
Value of total assets at beginning of year2021-09-30$3,215,034
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$243,313
Total interest from all sources2021-09-30$12
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Administrative expenses professional fees incurred2021-09-30$203,317
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$500,000
If this is an individual account plan, was there a blackout period2021-09-30No
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$1,380,053
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$54,304
Value of net assets at end of year (total assets less liabilities)2021-09-30$2,699,860
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$2,645,556
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-09-30$3,256,989
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-09-30$3,215,034
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-09-30$3,215,034
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-09-30$12
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$961,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30No
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$3,460,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$3,581,280
Contract administrator fees2021-09-30$39,996
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-09-30No
Liabilities. Value of benefit claims payable at end of year2021-09-30$557,129
Liabilities. Value of benefit claims payable at beginning of year2021-09-30$569,478
Did the plan have assets held for investment2021-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30CCK STRATEGIES
Accountancy firm EIN2021-09-30731528194
2020 : FABRICUT, INC. HEALTH PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$569,478
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$434,276
Total income from all sources (including contributions)2020-09-30$4,901,548
Total of all expenses incurred2020-09-30$5,019,228
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$4,762,968
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$4,883,374
Value of total assets at end of year2020-09-30$3,215,034
Value of total assets at beginning of year2020-09-30$3,197,512
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$256,260
Total interest from all sources2020-09-30$18,174
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Administrative expenses professional fees incurred2020-09-30$216,264
Was this plan covered by a fidelity bond2020-09-30Yes
Value of fidelity bond cover2020-09-30$500,000
If this is an individual account plan, was there a blackout period2020-09-30No
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$1,433,374
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$-117,680
Value of net assets at end of year (total assets less liabilities)2020-09-30$2,645,556
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$2,763,236
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-09-30$3,215,034
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-09-30$3,197,512
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-09-30$3,197,512
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-09-30$18,174
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$929,619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30No
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$3,450,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-09-30$3,833,349
Contract administrator fees2020-09-30$39,996
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-09-30No
Liabilities. Value of benefit claims payable at end of year2020-09-30$569,478
Liabilities. Value of benefit claims payable at beginning of year2020-09-30$434,276
Did the plan have assets held for investment2020-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30CCK STRATEGIES
Accountancy firm EIN2020-09-30731528194
2019 : FABRICUT, INC. HEALTH PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$434,276
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$456,594
Total income from all sources (including contributions)2019-09-30$4,316,573
Total of all expenses incurred2019-09-30$4,257,490
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$3,996,798
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$4,279,237
Value of total assets at end of year2019-09-30$3,197,512
Value of total assets at beginning of year2019-09-30$3,160,747
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$260,692
Total interest from all sources2019-09-30$37,336
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Administrative expenses professional fees incurred2019-09-30$220,663
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$500,000
If this is an individual account plan, was there a blackout period2019-09-30No
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$1,382,237
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$59,083
Value of net assets at end of year (total assets less liabilities)2019-09-30$2,763,236
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$2,704,153
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-09-30$3,197,512
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-09-30$3,160,747
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-09-30$3,160,747
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-09-30$37,336
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$875,993
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$2,897,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$3,120,805
Contract administrator fees2019-09-30$40,029
Liabilities. Value of benefit claims payable at end of year2019-09-30$434,276
Liabilities. Value of benefit claims payable at beginning of year2019-09-30$456,594
Did the plan have assets held for investment2019-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30CCK STRATEGIES PLLC
Accountancy firm EIN2019-09-30731528194
2018 : FABRICUT, INC. HEALTH PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$456,594
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$317,318
Total income from all sources (including contributions)2018-09-30$4,352,029
Total loss/gain on sale of assets2018-09-30$0
Total of all expenses incurred2018-09-30$4,488,440
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$4,221,872
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$4,348,279
Value of total assets at end of year2018-09-30$3,160,747
Value of total assets at beginning of year2018-09-30$3,157,882
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$266,568
Total interest from all sources2018-09-30$3,750
Total dividends received (eg from common stock, registered investment company shares)2018-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Administrative expenses professional fees incurred2018-09-30$181,104
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$1,297,279
Total non interest bearing cash at end of year2018-09-30$3,160,747
Total non interest bearing cash at beginning of year2018-09-30$3,157,882
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$-136,411
Value of net assets at end of year (total assets less liabilities)2018-09-30$2,704,153
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$2,840,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-09-30$3,750
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$824,913
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30No
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$3,051,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-09-30$3,396,959
Contract administrator fees2018-09-30$85,464
Liabilities. Value of benefit claims payable at end of year2018-09-30$456,594
Liabilities. Value of benefit claims payable at beginning of year2018-09-30$317,318
Did the plan have assets held for investment2018-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30CCK STRATEGIES PLLC
Accountancy firm EIN2018-09-30731528194
2017 : FABRICUT, INC. HEALTH PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$317,318
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$382,117
Total income from all sources (including contributions)2017-09-30$3,967,318
Total loss/gain on sale of assets2017-09-30$0
Total of all expenses incurred2017-09-30$3,917,761
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$3,680,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$3,967,318
Value of total assets at end of year2017-09-30$3,157,882
Value of total assets at beginning of year2017-09-30$3,173,124
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$237,729
Total interest from all sources2017-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Administrative expenses professional fees incurred2017-09-30$65,000
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$1,197,318
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-09-30$21,167
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-09-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-09-30$14,818
Total non interest bearing cash at end of year2017-09-30$3,157,882
Total non interest bearing cash at beginning of year2017-09-30$3,158,306
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$49,557
Value of net assets at end of year (total assets less liabilities)2017-09-30$2,840,564
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$2,791,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$745,194
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30No
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$2,770,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-09-30$2,913,671
Contract administrator fees2017-09-30$172,729
Liabilities. Value of benefit claims payable at end of year2017-09-30$317,318
Liabilities. Value of benefit claims payable at beginning of year2017-09-30$382,117
Did the plan have assets held for investment2017-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2017-09-30431947695
2016 : FABRICUT, INC. HEALTH PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$382,117
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$423,565
Total income from all sources (including contributions)2016-09-30$3,880,081
Total loss/gain on sale of assets2016-09-30$0
Total of all expenses incurred2016-09-30$3,846,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$3,610,125
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$3,880,081
Value of total assets at end of year2016-09-30$3,173,124
Value of total assets at beginning of year2016-09-30$3,181,437
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$236,821
Total interest from all sources2016-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Administrative expenses professional fees incurred2016-09-30$60,750
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$1,106,081
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-09-30$18,445
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-09-30$14,818
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-09-30$0
Total non interest bearing cash at end of year2016-09-30$3,158,306
Total non interest bearing cash at beginning of year2016-09-30$3,158,637
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$33,135
Value of net assets at end of year (total assets less liabilities)2016-09-30$2,791,007
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$2,757,872
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$707,353
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$2,774,000
Employer contributions (assets) at end of year2016-09-30$0
Employer contributions (assets) at beginning of year2016-09-30$22,800
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$2,884,327
Contract administrator fees2016-09-30$176,071
Liabilities. Value of benefit claims payable at end of year2016-09-30$382,117
Liabilities. Value of benefit claims payable at beginning of year2016-09-30$423,565
Did the plan have assets held for investment2016-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2016-09-30431947695
2015 : FABRICUT, INC. HEALTH PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$423,565
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$358,391
Total income from all sources (including contributions)2015-09-30$3,588,750
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$3,695,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$3,485,754
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$3,588,750
Value of total assets at end of year2015-09-30$3,181,437
Value of total assets at beginning of year2015-09-30$3,223,339
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$210,072
Total interest from all sources2015-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Administrative expenses professional fees incurred2015-09-30$30,000
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$1,130,750
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-09-30$4,480
Total non interest bearing cash at end of year2015-09-30$3,158,637
Total non interest bearing cash at beginning of year2015-09-30$3,177,627
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$-107,076
Value of net assets at end of year (total assets less liabilities)2015-09-30$2,757,872
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$2,864,948
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$673,686
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$2,458,000
Employer contributions (assets) at end of year2015-09-30$22,800
Employer contributions (assets) at beginning of year2015-09-30$45,712
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$2,807,588
Contract administrator fees2015-09-30$180,072
Liabilities. Value of benefit claims payable at end of year2015-09-30$423,565
Liabilities. Value of benefit claims payable at beginning of year2015-09-30$358,391
Did the plan have assets held for investment2015-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30No
Opinion of an independent qualified public accountant for this plan2015-09-30Unqualified
Accountancy firm name2015-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2015-09-30431947695
2014 : FABRICUT, INC. HEALTH PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$358,391
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$410,800
Total income from all sources (including contributions)2014-09-30$3,191,827
Total loss/gain on sale of assets2014-09-30$0
Total of all expenses incurred2014-09-30$3,165,816
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$2,964,566
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$3,191,827
Value of total assets at end of year2014-09-30$3,223,339
Value of total assets at beginning of year2014-09-30$3,249,737
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$201,250
Total interest from all sources2014-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Administrative expenses professional fees incurred2014-09-30$201,250
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$1,097,827
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-09-30$62,578
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-09-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-09-30$71,887
Total non interest bearing cash at end of year2014-09-30$3,177,627
Total non interest bearing cash at beginning of year2014-09-30$3,177,850
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$26,011
Value of net assets at end of year (total assets less liabilities)2014-09-30$2,864,948
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$2,838,937
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$572,103
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30No
Was there a failure to transmit to the plan any participant contributions2014-09-30No
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$2,094,000
Employer contributions (assets) at end of year2014-09-30$45,712
Employer contributions (assets) at beginning of year2014-09-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-09-30$2,329,885
Liabilities. Value of benefit claims payable at end of year2014-09-30$358,391
Liabilities. Value of benefit claims payable at beginning of year2014-09-30$410,800
Did the plan have assets held for investment2014-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30No
Opinion of an independent qualified public accountant for this plan2014-09-30Unqualified
Accountancy firm name2014-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2014-09-30431947695
2013 : FABRICUT, INC. HEALTH PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$410,800
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$329,304
Total income from all sources (including contributions)2013-09-30$3,486,454
Total loss/gain on sale of assets2013-09-30$0
Total of all expenses incurred2013-09-30$3,496,727
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$3,315,663
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$3,486,454
Value of total assets at end of year2013-09-30$3,249,737
Value of total assets at beginning of year2013-09-30$3,178,514
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$181,064
Total interest from all sources2013-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Administrative expenses professional fees incurred2013-09-30$181,064
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$1,036,454
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-09-30$1,213
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-09-30$71,887
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-09-30$324,480
Total non interest bearing cash at end of year2013-09-30$3,177,850
Total non interest bearing cash at beginning of year2013-09-30$2,854,034
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Value of net income/loss2013-09-30$-10,273
Value of net assets at end of year (total assets less liabilities)2013-09-30$2,838,937
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$2,849,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$561,199
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30No
Was there a failure to transmit to the plan any participant contributions2013-09-30No
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$2,450,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-09-30$2,753,251
Liabilities. Value of benefit claims payable at end of year2013-09-30$410,800
Liabilities. Value of benefit claims payable at beginning of year2013-09-30$329,304
Did the plan have assets held for investment2013-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30No
Opinion of an independent qualified public accountant for this plan2013-09-30Unqualified
Accountancy firm name2013-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2013-09-30431947695
2012 : FABRICUT, INC. HEALTH PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$736,222
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$695,132
Total income from all sources (including contributions)2012-09-30$4,246,994
Total loss/gain on sale of assets2012-09-30$0
Total of all expenses incurred2012-09-30$3,790,015
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$3,591,973
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-30$4,246,994
Value of total assets at end of year2012-09-30$2,968,621
Value of total assets at beginning of year2012-09-30$2,470,552
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$198,042
Total interest from all sources2012-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2012-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Administrative expenses professional fees incurred2012-09-30$198,042
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$3,000,000
If this is an individual account plan, was there a blackout period2012-09-30No
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Contributions received from participants2012-09-30$1,221,994
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-09-30$324,480
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-09-30$24,856
Total non interest bearing cash at end of year2012-09-30$2,968,621
Total non interest bearing cash at beginning of year2012-09-30$2,470,552
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$456,979
Value of net assets at end of year (total assets less liabilities)2012-09-30$2,232,399
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$1,775,420
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-09-30$687,252
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30No
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Contributions received in cash from employer2012-09-30$3,025,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-30$2,904,721
Liabilities. Value of benefit claims payable at end of year2012-09-30$736,222
Liabilities. Value of benefit claims payable at beginning of year2012-09-30$695,132
Did the plan have assets held for investment2012-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2012-09-30431947695
2011 : FABRICUT, INC. HEALTH PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$695,132
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$670,276
Total income from all sources (including contributions)2011-09-30$288,976
Total loss/gain on sale of assets2011-09-30$0
Total of all expenses incurred2011-09-30$814,528
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-09-30$772,266
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-09-30$288,976
Value of total assets at end of year2011-09-30$2,470,552
Value of total assets at beginning of year2011-09-30$2,971,248
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-09-30$42,262
Total interest from all sources2011-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2011-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-09-30No
Was this plan covered by a fidelity bond2011-09-30Yes
Value of fidelity bond cover2011-09-30$3,000,000
If this is an individual account plan, was there a blackout period2011-09-30No
Were there any nonexempt tranactions with any party-in-interest2011-09-30No
Contributions received from participants2011-09-30$288,976
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-09-30$24,856
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-09-30$0
Administrative expenses (other) incurred2011-09-30$42,262
Total non interest bearing cash at end of year2011-09-30$2,470,552
Total non interest bearing cash at beginning of year2011-09-30$2,971,248
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Value of net income/loss2011-09-30$-525,552
Value of net assets at end of year (total assets less liabilities)2011-09-30$1,775,420
Value of net assets at beginning of year (total assets less liabilities)2011-09-30$2,300,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-09-30No
Were any leases to which the plan was party in default or uncollectible2011-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-09-30$134,360
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-09-30No
Was there a failure to transmit to the plan any participant contributions2011-09-30No
Has the plan failed to provide any benefit when due under the plan2011-09-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-09-30$772,266
Contract administrator fees2011-09-30$42,610
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-09-30No
Liabilities. Value of benefit claims payable at end of year2011-09-30$695,132
Liabilities. Value of benefit claims payable at beginning of year2011-09-30$670,276
Did the plan have assets held for investment2011-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-09-30No
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$670,276
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$653,712
Total income from all sources (including contributions)2011-06-30$3,356,399
Total of all expenses incurred2011-06-30$3,376,545
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$3,191,270
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$3,356,399
Value of total assets at end of year2011-06-30$2,971,248
Value of total assets at beginning of year2011-06-30$2,974,830
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$185,275
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$3,000,000
If this is an individual account plan, was there a blackout period2011-06-30No
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$966,399
Total non interest bearing cash at end of year2011-06-30$2,971,248
Total non interest bearing cash at beginning of year2011-06-30$2,974,830
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$-20,146
Value of net assets at end of year (total assets less liabilities)2011-06-30$2,300,972
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$2,321,118
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Investment advisory and management fees2011-06-30$185,275
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30No
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$2,390,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$3,191,270
Liabilities. Value of benefit claims payable at end of year2011-06-30$670,276
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$653,712
Did the plan have assets held for investment2011-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30GRESHAM SMITH LLC
Accountancy firm EIN2011-06-30261393034

Form 5500 Responses for FABRICUT, INC. HEALTH PLAN

2021: FABRICUT, INC. HEALTH PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – TrustYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement - TrustYes
2020: FABRICUT, INC. HEALTH PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2019: FABRICUT, INC. HEALTH PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2018: FABRICUT, INC. HEALTH PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2017: FABRICUT, INC. HEALTH PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planNo
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2016: FABRICUT, INC. HEALTH PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2015: FABRICUT, INC. HEALTH PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2014: FABRICUT, INC. HEALTH PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: FABRICUT, INC. HEALTH PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: FABRICUT, INC. HEALTH PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: FABRICUT, INC. HEALTH PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedYes
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedYes
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: FABRICUT, INC. HEALTH PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedYes
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number01115648
Policy instance 2
Insurance contract or identification number01115648
Number of Individuals Covered381
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $4,746
Total amount of fees paid to insurance companyUSD $17,198
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,746
Amount paid for insurance broker fees17198
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 1
Insurance contract or identification number101556
Number of Individuals Covered10
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119877
Policy instance 3
Insurance contract or identification numberLTD119877
Number of Individuals Covered495
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $4,877
Total amount of fees paid to insurance companyUSD $5,290
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,877
Amount paid for insurance broker fees5290
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 4
Insurance contract or identification numberVAR 203495
Number of Individuals Covered141
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $2,534
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,534
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 5
Insurance contract or identification numberGL 139929
Number of Individuals Covered334
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $7,146
Total amount of fees paid to insurance companyUSD $10,729
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $214,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,146
Amount paid for insurance broker fees10729
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 6
Insurance contract or identification number8897
Number of Individuals Covered283
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,318
Total amount of fees paid to insurance companyUSD $14,211
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,318
Amount paid for insurance broker fees14211
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRI
Policy instance 7
Insurance contract or identification numberFABRI
Number of Individuals Covered387
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 8
Insurance contract or identification number894600
Number of Individuals Covered418
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $39,996
Total amount of fees paid to insurance companyUSD $178,708
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $668,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees178708
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $39,996
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 1
Insurance contract or identification number101556
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number01115648
Policy instance 2
Insurance contract or identification number01115648
Number of Individuals Covered350
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $5,086
Total amount of fees paid to insurance companyUSD $18,327
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,086
Amount paid for insurance broker fees18327
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 4
Insurance contract or identification numberVAR 203495
Number of Individuals Covered145
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $419
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $419
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 6
Insurance contract or identification number8897
Number of Individuals Covered273
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,168
Total amount of fees paid to insurance companyUSD $13,041
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,168
Amount paid for insurance broker fees13041
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 5
Insurance contract or identification numberGL 139929
Number of Individuals Covered339
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $193
Total amount of fees paid to insurance companyUSD $1,410
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $28,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $193
Amount paid for insurance broker fees1410
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119877
Policy instance 3
Insurance contract or identification numberLTD119877
Number of Individuals Covered339
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $1,432
Total amount of fees paid to insurance companyUSD $755
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,432
Amount paid for insurance broker fees755
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 8
Insurance contract or identification number894600
Number of Individuals Covered406
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $39,996
Total amount of fees paid to insurance companyUSD $137,774
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $433,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees137774
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $39,996
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRI
Policy instance 7
Insurance contract or identification numberFABRI
Number of Individuals Covered370
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $758,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRI
Policy instance 7
Insurance contract or identification numberFABRI
Number of Individuals Covered350
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $4,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 5
Insurance contract or identification numberGL 139929
Number of Individuals Covered374
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $3,642
Total amount of fees paid to insurance companyUSD $5,951
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $119,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,642
Amount paid for insurance broker fees5951
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119877
Policy instance 3
Insurance contract or identification numberLTD119877
Number of Individuals Covered374
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $3,174
Total amount of fees paid to insurance companyUSD $3,120
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,174
Amount paid for insurance broker fees3120
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number01115648
Policy instance 2
Insurance contract or identification number01115648
Number of Individuals Covered344
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $4,077
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,077
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 1
Insurance contract or identification number101556
Number of Individuals Covered12
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 4
Insurance contract or identification numberVAR 203495
Number of Individuals Covered152
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $1,772
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $11,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,772
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 6
Insurance contract or identification number8897
Number of Individuals Covered258
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,227
Total amount of fees paid to insurance companyUSD $12,327
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,227
Amount paid for insurance broker fees12327
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 8
Insurance contract or identification number894600
Number of Individuals Covered450
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $39,996
Total amount of fees paid to insurance companyUSD $143,590
Welfare Benefit Premiums Paid to CarrierUSD $433,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees143590
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE OTHER FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $39,996
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 8
Insurance contract or identification numberGL 139929
Number of Individuals Covered370
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $3,705
Total amount of fees paid to insurance companyUSD $6,098
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $121,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,705
Amount paid for insurance broker fees6098
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRI
Policy instance 7
Insurance contract or identification numberFABRI
Number of Individuals Covered391
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to CarrierUSD $4,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 6
Insurance contract or identification numberVAR 203495
Number of Individuals Covered138
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $1,647
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,647
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 5
Insurance contract or identification number8897
Number of Individuals Covered289
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,321
Total amount of fees paid to insurance companyUSD $14,522
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,321
Amount paid for insurance broker fees14522
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 4
Insurance contract or identification number894600
Number of Individuals Covered461
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $39,996
Total amount of fees paid to insurance companyUSD $179,691
Welfare Benefit Premiums Paid to CarrierUSD $358,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees179691
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $39,996
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119877
Policy instance 3
Insurance contract or identification numberLTD119877
Number of Individuals Covered369
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $3,157
Total amount of fees paid to insurance companyUSD $3,037
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,157
Amount paid for insurance broker fees3037
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 1
Insurance contract or identification number101556
Number of Individuals Covered11
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number01115648
Policy instance 2
Insurance contract or identification number01115648
Number of Individuals Covered372
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $4,880
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,880
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRI
Policy instance 8
Insurance contract or identification numberFABRI
Number of Individuals Covered391
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD119877
Policy instance 6
Insurance contract or identification numberLTD119877
Number of Individuals Covered364
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $3,278
Total amount of fees paid to insurance companyUSD $1,654
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $57,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered439
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $30,000
Total amount of fees paid to insurance companyUSD $171,619
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $269,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 5
Insurance contract or identification numberGL 139929
Number of Individuals Covered364
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $3,064
Total amount of fees paid to insurance companyUSD $3,544
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $120,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered17
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $122,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number01115648
Policy instance 7
Insurance contract or identification number01115648
Number of Individuals Covered373
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $4,898
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered286
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,322
Total amount of fees paid to insurance companyUSD $14,998
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 4
Insurance contract or identification numberVAR 203495
Number of Individuals Covered138
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $1,516
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered371
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $3,130
Total amount of fees paid to insurance companyUSD $700
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $58,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,130
Insurance broker organization code?3
Amount paid for insurance broker fees700
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRICUT
Policy instance 8
Insurance contract or identification numberFABRICUT
Number of Individuals Covered376
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered22
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $117,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 7
Insurance contract or identification numberVAR 203495
Number of Individuals Covered135
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $1,368
Total amount of fees paid to insurance companyUSD $108
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,368
Insurance broker organization code?3
Amount paid for insurance broker fees108
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered356
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $4,623
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,623
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL MIDWEST LIMITED
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered378
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $3,623
Total amount of fees paid to insurance companyUSD $1,360
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $111,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,623
Insurance broker organization code?3
Amount paid for insurance broker fees1360
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered292
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $5,490
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,490
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered456
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $211,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 7
Insurance contract or identification numberVAR 203495
Number of Individuals Covered133
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $1,302
Total amount of fees paid to insurance companyUSD $114
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,302
Insurance broker organization code?3
Amount paid for insurance broker fees114
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered376
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $3,290
Total amount of fees paid to insurance companyUSD $672
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $55,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,290
Insurance broker organization code?3
Amount paid for insurance broker fees672
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered379
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $749
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $749
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL MIDWEST LIMITED
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered440
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $199,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered284
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $6,399
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,399
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered26
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $106,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRICUT
Policy instance 8
Insurance contract or identification numberFABRICUT
Number of Individuals Covered381
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered354
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $3,598
Total amount of fees paid to insurance companyUSD $1,264
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $105,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,598
Insurance broker organization code?3
Amount paid for insurance broker fees1264
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered409
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $147,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRICUT
Policy instance 8
Insurance contract or identification numberFABRICUT
Number of Individuals Covered370
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered328
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $4,730
Total amount of fees paid to insurance companyUSD $297
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $99,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,730
Insurance broker organization code?3
Amount paid for insurance broker fees297
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 7
Insurance contract or identification numberVAR 203495
Number of Individuals Covered136
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $1,361
Total amount of fees paid to insurance companyUSD $27
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,361
Insurance broker organization code?3
Amount paid for insurance broker fees27
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameNFP INSURANCE SERVICES INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered346
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $4,091
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,091
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANISATION, INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered142
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $2,544
Total amount of fees paid to insurance companyUSD $151
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $53,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,499
Insurance broker organization code?3
Amount paid for insurance broker fees151
Additional information about fees paid to insurance brokerTOTAL ADMINISTRATIVE AND OTHER FEES
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered276
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $6,179
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,179
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered21
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $73,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered434
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,988
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $147,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1988
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberFABRICUT
Policy instance 8
Insurance contract or identification numberFABRICUT
Number of Individuals Covered352
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PLAN
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 7
Insurance contract or identification numberVAR 203495
Number of Individuals Covered136
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $1,441
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,441
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered330
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,719
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,719
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered333
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,001
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $48,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,001
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered328
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,552
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $100,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,552
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered16
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $73,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered258
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $5,595
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,595
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS ADVANTAGE LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered16
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $80,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered362
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $36,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered359
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $49,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered359
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $106,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered434
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $131,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered266
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $134,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number894600
Policy instance 1
Insurance contract or identification number894600
Number of Individuals Covered434
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $31,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 6
Insurance contract or identification number01115648
Number of Individuals Covered362
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered344
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 4
Insurance contract or identification numberGL 139929
Number of Individuals Covered344
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $24,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 3
Insurance contract or identification number8897
Number of Individuals Covered266
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $30,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101556
Policy instance 2
Insurance contract or identification number101556
Number of Individuals Covered9
Insurance policy start date2011-07-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $27,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number01115648
Policy instance 1
Insurance contract or identification number01115648
Number of Individuals Covered576
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,397
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8897
Policy instance 2
Insurance contract or identification number8897
Number of Individuals Covered239
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,595
Total amount of fees paid to insurance companyUSD $10,419
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number894600
Policy instance 4
Insurance contract or identification number894600
Number of Individuals Covered428
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,554
Welfare Benefit Premiums Paid to CarrierUSD $126,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 119877
Policy instance 5
Insurance contract or identification numberLTD 119877
Number of Individuals Covered319
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,818
Total amount of fees paid to insurance companyUSD $453
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203495
Policy instance 6
Insurance contract or identification numberVAR 203495
Number of Individuals Covered119
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,463
Total amount of fees paid to insurance companyUSD $57
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 139929
Policy instance 7
Insurance contract or identification numberGL 139929
Number of Individuals Covered339
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,481
Total amount of fees paid to insurance companyUSD $544
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $93,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract number34
Policy instance 3
Insurance contract or identification number34
Number of Individuals Covered347
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Welfare Benefit Premiums Paid to CarrierUSD $4,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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