ABC AUTO PARTS, LTD. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N
401k plan membership statisitcs for ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N
Measure | Date | Value |
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2022: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2022 401k membership |
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Total participants, beginning-of-year | 2022-02-01 | 288 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 258 |
Number of retired or separated participants receiving benefits | 2022-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
Total of all active and inactive participants | 2022-02-01 | 258 |
2021: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2021 401k membership |
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Total participants, beginning-of-year | 2021-02-01 | 299 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 287 |
Number of retired or separated participants receiving benefits | 2021-02-01 | 1 |
Total of all active and inactive participants | 2021-02-01 | 288 |
Total participants | 2021-02-01 | 288 |
2020: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2020 401k membership |
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Total participants, beginning-of-year | 2020-02-01 | 294 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 298 |
Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 1 |
Total of all active and inactive participants | 2020-02-01 | 299 |
Total participants | 2020-02-01 | 299 |
2019: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2019 401k membership |
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Total participants, beginning-of-year | 2019-02-01 | 284 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 293 |
Number of retired or separated participants receiving benefits | 2019-02-01 | 1 |
Total of all active and inactive participants | 2019-02-01 | 294 |
Total participants | 2019-02-01 | 294 |
2018: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2018 401k membership |
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Total participants, beginning-of-year | 2018-02-01 | 261 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 284 |
Total of all active and inactive participants | 2018-02-01 | 284 |
Total participants | 2018-02-01 | 284 |
2017: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2017 401k membership |
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Total participants, beginning-of-year | 2017-02-01 | 263 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 260 |
Number of retired or separated participants receiving benefits | 2017-02-01 | 1 |
Total of all active and inactive participants | 2017-02-01 | 261 |
Total participants | 2017-02-01 | 261 |
2016: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2016 401k membership |
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Total participants, beginning-of-year | 2016-02-01 | 213 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 228 |
Total of all active and inactive participants | 2016-02-01 | 228 |
Total participants | 2016-02-01 | 228 |
2015: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 401k membership |
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Total participants, beginning-of-year | 2015-02-01 | 224 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 213 |
Total of all active and inactive participants | 2015-02-01 | 213 |
Total participants | 2015-02-01 | 0 |
Total participants, beginning-of-year | 2015-01-01 | 349 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 338 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 338 |
Total participants | 2015-01-01 | 338 |
2014: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 401k membership |
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Total participants, beginning-of-year | 2014-02-01 | 0 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 0 |
Total of all active and inactive participants | 2014-02-01 | 0 |
Total participants | 2014-02-01 | 0 |
Total participants, beginning-of-year | 2014-01-01 | 354 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 349 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 349 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
2013: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 401k membership |
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Total participants, beginning-of-year | 2013-02-01 | 72 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 72 |
Total of all active and inactive participants | 2013-02-01 | 72 |
Total participants, beginning-of-year | 2013-01-01 | 353 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 354 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 354 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
2012: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 401k membership |
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Total participants, beginning-of-year | 2012-02-01 | 71 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 72 |
Total of all active and inactive participants | 2012-02-01 | 72 |
Total participants, beginning-of-year | 2012-01-01 | 340 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 351 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
Total of all active and inactive participants | 2012-01-01 | 351 |
2011: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 401k membership |
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Total participants, beginning-of-year | 2011-02-01 | 71 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 71 |
Total of all active and inactive participants | 2011-02-01 | 71 |
2009: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2009 401k membership |
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Total participants, beginning-of-year | 2009-02-01 | 74 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 69 |
Total of all active and inactive participants | 2009-02-01 | 69 |
Measure | Date | Value |
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2015 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 401k financial data |
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Total income from all sources (including contributions) | 2015-01-31 | $1,751,139 |
Total of all expenses incurred | 2015-01-31 | $1,751,621 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-01-31 | $1,560,490 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-01-31 | $1,751,139 |
Value of total assets at end of year | 2015-01-31 | $320 |
Value of total assets at beginning of year | 2015-01-31 | $802 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-01-31 | $191,131 |
Total income from all sources | 2015-01-31 | $43,860 |
Expenses. Total of all expenses incurred | 2015-01-31 | $96,340 |
Benefits paid (including direct rollovers) | 2015-01-31 | $81,132 |
Total plan assets at end of year | 2015-01-31 | $320 |
Total plan assets at beginning of year | 2015-01-31 | $52,800 |
Expenses. Other expenses not covered elsewhere | 2015-01-31 | $15,208 |
Net income (gross income less expenses) | 2015-01-31 | $-52,480 |
Net plan assets at end of year (total assets less liabilities) | 2015-01-31 | $320 |
Net plan assets at beginning of year (total assets less liabilities) | 2015-01-31 | $52,800 |
Total contributions received or receivable from employer(s) | 2015-01-31 | $43,860 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-01-31 | No |
Was this plan covered by a fidelity bond | 2015-01-31 | Yes |
Value of fidelity bond cover | 2015-01-31 | $500,000 |
If this is an individual account plan, was there a blackout period | 2015-01-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2015-01-31 | No |
Contributions received from participants | 2015-01-31 | $685,278 |
Total non interest bearing cash at end of year | 2015-01-31 | $320 |
Total non interest bearing cash at beginning of year | 2015-01-31 | $802 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
Value of net income/loss | 2015-01-31 | $-482 |
Value of net assets at end of year (total assets less liabilities) | 2015-01-31 | $320 |
Value of net assets at beginning of year (total assets less liabilities) | 2015-01-31 | $802 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-01-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-01-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-01-31 | No |
Value of interest in common/collective trusts at end of year | 2015-01-31 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2015-01-31 | $609,170 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-01-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2015-01-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2015-01-31 | No |
Contributions received in cash from employer | 2015-01-31 | $1,065,861 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-01-31 | $951,320 |
Contract administrator fees | 2015-01-31 | $191,131 |
Did the plan have assets held for investment | 2015-01-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-01-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-01-31 | No |
Opinion of an independent qualified public accountant for this plan | 2015-01-31 | Unqualified |
Accountancy firm name | 2015-01-31 | CURTIS BLAKELY & CO., PC |
Accountancy firm EIN | 2015-01-31 | 751546734 |
2014 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 401k financial data |
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Total income from all sources | 2014-01-31 | $1,734,937 |
Expenses. Total of all expenses incurred | 2014-01-31 | $1,683,957 |
Benefits paid (including direct rollovers) | 2014-01-31 | $1,637,079 |
Total plan assets at end of year | 2014-01-31 | $52,800 |
Total plan assets at beginning of year | 2014-01-31 | $1,820 |
Expenses. Other expenses not covered elsewhere | 2014-01-31 | $46,878 |
Net income (gross income less expenses) | 2014-01-31 | $50,980 |
Net plan assets at end of year (total assets less liabilities) | 2014-01-31 | $52,800 |
Net plan assets at beginning of year (total assets less liabilities) | 2014-01-31 | $1,820 |
Total contributions received or receivable from employer(s) | 2014-01-31 | $1,734,937 |
2013 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 401k financial data |
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Total income from all sources | 2013-01-31 | $1,652,149 |
Expenses. Total of all expenses incurred | 2013-01-31 | $1,661,353 |
Benefits paid (including direct rollovers) | 2013-01-31 | $1,621,130 |
Total plan assets at end of year | 2013-01-31 | $1,820 |
Total plan assets at beginning of year | 2013-01-31 | $11,024 |
Expenses. Other expenses not covered elsewhere | 2013-01-31 | $40,223 |
Other income received | 2013-01-31 | $305,270 |
Net income (gross income less expenses) | 2013-01-31 | $-9,204 |
Net plan assets at end of year (total assets less liabilities) | 2013-01-31 | $1,820 |
Net plan assets at beginning of year (total assets less liabilities) | 2013-01-31 | $11,024 |
Total contributions received or receivable from employer(s) | 2013-01-31 | $1,346,879 |
2012 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 401k financial data |
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Total plan liabilities at beginning of year | 2012-01-31 | $28,625 |
Total income from all sources | 2012-01-31 | $1,885,092 |
Expenses. Total of all expenses incurred | 2012-01-31 | $1,874,068 |
Benefits paid (including direct rollovers) | 2012-01-31 | $1,835,751 |
Total plan assets at end of year | 2012-01-31 | $11,024 |
Total plan assets at beginning of year | 2012-01-31 | $28,625 |
Other income received | 2012-01-31 | $561,445 |
Net income (gross income less expenses) | 2012-01-31 | $11,024 |
Net plan assets at end of year (total assets less liabilities) | 2012-01-31 | $11,024 |
Net plan assets at beginning of year (total assets less liabilities) | 2012-01-31 | $0 |
Total contributions received or receivable from employer(s) | 2012-01-31 | $1,323,647 |
Expenses. Administrative service providers (salaries,fees and commissions) | 2012-01-31 | $38,317 |
2011 : ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 401k financial data |
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Total plan liabilities at end of year | 2011-01-31 | $28,625 |
Total plan liabilities at beginning of year | 2011-01-31 | $50,479 |
Total income from all sources | 2011-01-31 | $1,193,390 |
Expenses. Total of all expenses incurred | 2011-01-31 | $1,193,390 |
Benefits paid (including direct rollovers) | 2011-01-31 | $1,156,217 |
Total plan assets at end of year | 2011-01-31 | $28,625 |
Total plan assets at beginning of year | 2011-01-31 | $50,479 |
Other income received | 2011-01-31 | $179,192 |
Net income (gross income less expenses) | 2011-01-31 | $0 |
Net plan assets at end of year (total assets less liabilities) | 2011-01-31 | $0 |
Net plan assets at beginning of year (total assets less liabilities) | 2011-01-31 | $0 |
Total contributions received or receivable from employer(s) | 2011-01-31 | $1,014,198 |
Expenses. Administrative service providers (salaries,fees and commissions) | 2011-01-31 | $37,173 |
2022: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2022 form 5500 responses |
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2022-02-01 | Type of plan entity | Single employer plan |
2022-02-01 | Submission has been amended | No |
2022-02-01 | This submission is the final filing | No |
2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-02-01 | Plan is a collectively bargained plan | No |
2022-02-01 | Plan funding arrangement – Insurance | Yes |
2022-02-01 | Plan benefit arrangement – Insurance | Yes |
2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2021 form 5500 responses |
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2021-02-01 | Type of plan entity | Single employer plan |
2021-02-01 | Plan funding arrangement – Insurance | Yes |
2021-02-01 | Plan benefit arrangement – Insurance | Yes |
2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2020 form 5500 responses |
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2020-02-01 | Type of plan entity | Single employer plan |
2020-02-01 | Plan funding arrangement – Insurance | Yes |
2020-02-01 | Plan benefit arrangement – Insurance | Yes |
2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2019 form 5500 responses |
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2019-02-01 | Type of plan entity | Single employer plan |
2019-02-01 | Plan funding arrangement – Insurance | Yes |
2019-02-01 | Plan benefit arrangement – Insurance | Yes |
2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2018 form 5500 responses |
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2018-02-01 | Type of plan entity | Single employer plan |
2018-02-01 | Plan funding arrangement – Insurance | Yes |
2018-02-01 | Plan benefit arrangement – Insurance | Yes |
2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2017 form 5500 responses |
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2017-02-01 | Type of plan entity | Single employer plan |
2017-02-01 | Plan funding arrangement – Insurance | Yes |
2017-02-01 | Plan benefit arrangement – Insurance | Yes |
2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2016 form 5500 responses |
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2016-02-01 | Type of plan entity | Single employer plan |
2016-02-01 | Plan funding arrangement – Insurance | Yes |
2016-02-01 | Plan benefit arrangement – Insurance | Yes |
2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2015 form 5500 responses |
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2015-02-01 | Type of plan entity | Single employer plan |
2015-02-01 | Plan funding arrangement – Insurance | Yes |
2015-02-01 | Plan benefit arrangement – Insurance | Yes |
2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2014 form 5500 responses |
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2014-02-01 | Type of plan entity | Single employer plan |
2014-02-01 | Plan is a collectively bargained plan | Yes |
2014-02-01 | Plan funding arrangement – Insurance | Yes |
2014-02-01 | Plan funding arrangement – Trust | Yes |
2014-02-01 | Plan benefit arrangement – Insurance | Yes |
2014-02-01 | Plan benefit arrangement - Trust | Yes |
2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Submission has been amended | No |
2014-01-01 | This submission is the final filing | No |
2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-01-01 | Plan is a collectively bargained plan | No |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2013 form 5500 responses |
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2013-02-01 | Type of plan entity | Single employer plan |
2013-02-01 | Plan funding arrangement – Insurance | Yes |
2013-02-01 | Plan funding arrangement – Trust | Yes |
2013-02-01 | Plan benefit arrangement – Insurance | Yes |
2013-02-01 | Plan benefit arrangement - Trust | Yes |
2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Submission has been amended | No |
2013-01-01 | This submission is the final filing | No |
2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-01-01 | Plan is a collectively bargained plan | No |
2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2012 form 5500 responses |
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2012-02-01 | Type of plan entity | Single employer plan |
2012-02-01 | Plan funding arrangement – Insurance | Yes |
2012-02-01 | Plan funding arrangement – Trust | Yes |
2012-02-01 | Plan benefit arrangement – Insurance | Yes |
2012-02-01 | Plan benefit arrangement - Trust | Yes |
2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Submission has been amended | No |
2012-01-01 | This submission is the final filing | No |
2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-01-01 | Plan is a collectively bargained plan | No |
2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2011 form 5500 responses |
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2011-02-01 | Type of plan entity | Single employer plan |
2011-02-01 | Plan funding arrangement – Insurance | Yes |
2011-02-01 | Plan funding arrangement – Trust | Yes |
2011-02-01 | Plan benefit arrangement – Insurance | Yes |
2011-02-01 | Plan benefit arrangement - Trust | Yes |
2009: ABC AUTO PARTS LTD OCCUPATIONAL INJURY BENEFIT PLA N 2009 form 5500 responses |
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2009-02-01 | Type of plan entity | Single employer plan |
2009-02-01 | This submission is the final filing | No |
2009-02-01 | Plan funding arrangement – Insurance | Yes |
2009-02-01 | Plan funding arrangement – Trust | Yes |
2009-02-01 | Plan benefit arrangement – Insurance | Yes |
2009-02-01 | Plan benefit arrangement - Trust | Yes |
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 133970 |
Policy instance | 3 |
Insurance contract or identification number | 133970 | Number of Individuals Covered | 230 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $35,837 | Total amount of fees paid to insurance company | USD $8,952 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $476,092 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,837 | Amount paid for insurance broker fees | 8458 | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 258 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $3,096 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $30,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,077 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0870H |
Policy instance | 1 |
Insurance contract or identification number | GLUG0870H | Number of Individuals Covered | 214 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $2,029 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND 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 Carrier | USD $10,142 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,029 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 217 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $2,035 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $10,175 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,035 | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 258 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $3,113 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,113 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 220 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $2,041 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $10,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,041 | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 238 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $2,998 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,977 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,998 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 233 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $2,045 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $10,224 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,045 | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 232 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $2,773 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,734 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,773 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 234 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $1,975 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,975 | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 206 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $2,791 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,909 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,791 | Insurance broker organization code? | 3 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460 |
Policy instance | 2 |
Insurance contract or identification number | 307460 | Number of Individuals Covered | 195 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $2,869 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,488 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,869 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 211 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $1,956 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,781 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,956 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460-5 |
Policy instance | 2 |
Insurance contract or identification number | 307460-5 | Number of Individuals Covered | 203 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $2,367 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,717 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,367 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 201 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,860 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,302 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,860 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 307460-5 |
Policy instance | 2 |
Insurance contract or identification number | 307460-5 | Number of Individuals Covered | 154 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $252 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $252 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000870H |
Policy instance | 1 |
Insurance contract or identification number | G000870H | Number of Individuals Covered | 181 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $1,440 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,202 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,440 | Insurance broker organization code? | 3 | Insurance broker name | RANDALL SCOTT WARD |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL31015 |
Policy instance | 3 |
Insurance contract or identification number | HCL31015 | Number of Individuals Covered | 181 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $29,033 | Welfare Benefit Premiums Paid to Carrier | USD $580,653 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,033 | Insurance broker organization code? | 3 | Insurance broker name | CENTERSTONE INS & FIN SERVICES, INC |
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MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 3 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $1,906 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $7,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,906 | Insurance broker organization code? | 5 | Insurance broker name | IMA, INC. |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $548 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD AND D | Welfare Benefit Premiums Paid to Carrier | USD $2,701 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $548 | Insurance broker organization code? | 5 | Insurance broker name | IMA, INC. |
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IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 1 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $699 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PRE-CERTIFICATION | Welfare Benefit Premiums Paid to Carrier | USD $3,366 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $699 | Insurance broker organization code? | 5 | Insurance broker name | IMA, INC. |
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GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 4 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $81,056 | Total amount of fees paid to insurance company | USD $42,431 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPLIANCE | Welfare Benefit Premiums Paid to Carrier | USD $537,272 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $81,056 | Amount paid for insurance broker fees | 34811 | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | Insurance broker organization code? | 5 | Insurance broker name | RANDALL SCOTT |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $540 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD AND D | Welfare Benefit Premiums Paid to Carrier | USD $2,663 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $540 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 3 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $1,021 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $4,751 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,021 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 1 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $488 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PRE-CERTIFICATION | Welfare Benefit Premiums Paid to Carrier | USD $2,353 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $488 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 4 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 72 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $43,641 | Total amount of fees paid to insurance company | USD $30,273 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPLIANCE | Welfare Benefit Premiums Paid to Carrier | USD $288,419 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $43,641 | Amount paid for insurance broker fees | 24945 | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | Insurance broker organization code? | 5 | Insurance broker name | HIGGINBOTHAM |
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TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 4 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $35,364 | Total amount of fees paid to insurance company | USD $28,878 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPLIANCE | Welfare Benefit Premiums Paid to Carrier | USD $233,084 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 1 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $468 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PRE-CERTIFICATION | Welfare Benefit Premiums Paid to Carrier | USD $2,255 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $527 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD AND D | Welfare Benefit Premiums Paid to Carrier | USD $2,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 3 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $979 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $4,383 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BEECHSTREET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 3 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $1,034 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $4,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,034 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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IPROCERT (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 1 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $494 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | PRE-CERTIFICATION | Welfare Benefit Premiums Paid to Carrier | USD $2,382 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $494 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 4 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $30,197 | Total amount of fees paid to insurance company | USD $26,531 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | COMPLIANCE | Welfare Benefit Premiums Paid to Carrier | USD $199,031 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,197 | Amount paid for insurance broker fees | 21137 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 | Insurance broker name | CHARLES JOHNSON |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
Policy contract number | NOT AVAILABLE |
Policy instance | 2 |
Insurance contract or identification number | NOT AVAILABLE | Number of Individuals Covered | 71 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $544 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD AND D | Welfare Benefit Premiums Paid to Carrier | USD $2,682 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $544 | Insurance broker organization code? | 5 | Insurance broker name | INSURANCE MANAGEMENT ADMINISTRATORS |
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