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TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameTOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number 504

TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name:TOOTSIES INC
Employer identification number (EIN):741812563
NAIC Classification:448120
NAIC Description:Women's Clothing Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042019-11-01MARICA FOTINOS2021-03-03
5042018-11-01MARICA FOTINOS2020-02-19
5042017-11-01MARICA FOTINOS2019-04-25
5042016-11-01
5042016-10-01
5042015-10-01
5042014-10-01
5042011-10-01BRIAN KAPCHINSKIE
5042010-10-01BRIAN KAPCHINSKIE
5042009-10-01BRIAN KAPCHINSKIE

Plan Statistics for TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2019: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01134
Total number of active participants reported on line 7a of the Form 55002019-11-0178
Number of retired or separated participants receiving benefits2019-11-011
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-0179
Number of employers contributing to the scheme2019-11-010
2018: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01125
Total number of active participants reported on line 7a of the Form 55002018-11-01130
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-01130
Number of employers contributing to the scheme2018-11-010
2017: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01124
Total number of active participants reported on line 7a of the Form 55002017-11-01121
Number of retired or separated participants receiving benefits2017-11-013
Number of other retired or separated participants entitled to future benefits2017-11-011
Total of all active and inactive participants2017-11-01125
Number of employers contributing to the scheme2017-11-010
2016: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01119
Total number of active participants reported on line 7a of the Form 55002016-11-01123
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01123
Total participants, beginning-of-year2016-10-01117
Total number of active participants reported on line 7a of the Form 55002016-10-01119
Total of all active and inactive participants2016-10-01119
Total participants2016-10-01119
2015: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01100
Total number of active participants reported on line 7a of the Form 55002015-10-01117
Total of all active and inactive participants2015-10-01117
Total participants2015-10-01117
2014: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01108
Total number of active participants reported on line 7a of the Form 55002014-10-01100
Total of all active and inactive participants2014-10-01100
Total participants2014-10-01100
2011: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01108
Total number of active participants reported on line 7a of the Form 55002011-10-0182
Total of all active and inactive participants2011-10-0182
Total participants2011-10-0182
2010: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01141
Total number of active participants reported on line 7a of the Form 55002010-10-01108
Total of all active and inactive participants2010-10-01108
Total participants2010-10-01108
2009: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01178
Total number of active participants reported on line 7a of the Form 55002009-10-01141
Total of all active and inactive participants2009-10-01141
Total participants2009-10-01141

Form 5500 Responses for TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN

2019: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2018: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-10-01Type of plan entitySingle employer plan
2016-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2011: TOOTSIES INC EMPLOYEE WELFARE BENEFIT 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 benefit arrangement – InsuranceYes
2010: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: TOOTSIES INC EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AQX7
Policy instance 3
Insurance contract or identification numberGLUG0AQX7
Number of Individuals Covered85
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $15,280
Total amount of fees paid to insurance companyUSD $2,917
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $92,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,280
Amount paid for insurance broker fees2917
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number73280
Policy instance 2
Insurance contract or identification number73280
Number of Individuals Covered74
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $30,349
Total amount of fees paid to insurance companyUSD $1,029
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $602,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $30,349
Amount paid for insurance broker fees1029
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7317381
Policy instance 1
Insurance contract or identification numberE7317381
Number of Individuals Covered48
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $7,999
Total amount of fees paid to insurance companyUSD $292
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,854
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7317381
Policy instance 1
Insurance contract or identification numberE7317381
Number of Individuals Covered50
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $7,585
Total amount of fees paid to insurance companyUSD $195
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,657
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number788399
Policy instance 2
Insurance contract or identification number788399
Number of Individuals Covered80
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $1,786
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,786
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number73280
Policy instance 3
Insurance contract or identification number73280
Number of Individuals Covered131
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $35,829
Total amount of fees paid to insurance companyUSD $710
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $733,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $35,829
Amount paid for insurance broker fees710
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AQX7
Policy instance 4
Insurance contract or identification numberGLUG0AQX7
Number of Individuals Covered130
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $7,032
Total amount of fees paid to insurance companyUSD $2,084
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $35,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,032
Amount paid for insurance broker fees2084
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7317381
Policy instance 1
Insurance contract or identification numberE7317381
Number of Individuals Covered49
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $9,019
Total amount of fees paid to insurance companyUSD $406
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number788399
Policy instance 2
Insurance contract or identification number788399
Number of Individuals Covered79
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,692
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 number73280
Policy instance 3
Insurance contract or identification number73280
Number of Individuals Covered105
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $33,393
Total amount of fees paid to insurance companyUSD $338
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $652,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AQX7
Policy instance 4
Insurance contract or identification numberGLUG0AQX7
Number of Individuals Covered120
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $6,516
Total amount of fees paid to insurance companyUSD $1,641
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $32,581
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 number073280
Policy instance 1
Insurance contract or identification number073280
Number of Individuals Covered70
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $22,456
Total amount of fees paid to insurance companyUSD $849
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $486,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,456
Amount paid for insurance broker fees849
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameAGO/PLUMHOFF & ASSOC./USI SOUTHWEST
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AQX7
Policy instance 2
Insurance contract or identification numberG000AQX7
Number of Individuals Covered104
Insurance policy start date2013-11-01
Insurance policy end date2014-11-01
Total amount of commissions paid to insurance brokerUSD $1,832
Total amount of fees paid to insurance companyUSD $52
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,832
Amount paid for insurance broker fees52
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI SOUTHWEST, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AQX7
Policy instance 3
Insurance contract or identification numberG000AQX7
Number of Individuals Covered104
Insurance policy start date2013-11-01
Insurance policy end date2014-11-01
Total amount of commissions paid to insurance brokerUSD $3,829
Total amount of fees paid to insurance companyUSD $112
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,829
Amount paid for insurance broker fees112
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI SOUTHWEST, INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS1935
Policy instance 4
Insurance contract or identification numberVS1935
Number of Individuals Covered55
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05756954
Policy instance 5
Insurance contract or identification numberKM05756954
Number of Individuals Covered133
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $6,954
Total amount of fees paid to insurance companyUSD $433
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,954
Amount paid for insurance broker fees433
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameANCO INS SERVICES OF HOUSTON, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10033623
Policy instance 3
Insurance contract or identification number10033623
Number of Individuals Covered103
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $3,835
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05756954
Policy instance 4
Insurance contract or identification numberKM05756954
Number of Individuals Covered111
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $4,975
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,148
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 number73280
Policy instance 1
Insurance contract or identification number73280
Number of Individuals Covered71
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $24,119
Total amount of fees paid to insurance companyUSD $2,870
Welfare Benefit Premiums Paid to CarrierUSD $483,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10064136
Policy instance 5
Insurance contract or identification number10064136
Number of Individuals Covered103
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $1,460
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS1935
Policy instance 2
Insurance contract or identification numberVS1935
Number of Individuals Covered39
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $806
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract numberVS1935
Policy instance 3
Insurance contract or identification numberVS1935
Number of Individuals Covered37
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $55
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010033623
Policy instance 4
Insurance contract or identification number000010033623
Number of Individuals Covered110
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $3,868
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
Policy contract numberUS299641
Policy instance 1
Insurance contract or identification numberUS299641
Number of Individuals Covered132
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $30,585
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $508,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010064136
Policy instance 5
Insurance contract or identification number000010064136
Number of Individuals Covered110
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $1,516
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0042108
Policy instance 2
Insurance contract or identification number0042108
Number of Individuals Covered67
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $3,611
Total amount of fees paid to insurance companyUSD $1,322
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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