401k Plan data: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN plan

TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	503

TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare 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) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: TRUDELL HOLDINGS, INC.

Employer identification number (EIN): 752976432

NAIC Classification: 441228
NAIC Description: Motorcycle, ATV, and All Other Motor Vehicle Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-12-01
503 2021-01-01
503 2020-01-01

Plan Statistics for TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 299
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 0
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 0
Total participants, beginning-of-year 2021-01-01 298
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 290
Number of retired or separated participants receiving benefits 2021-01-01 1
Total of all active and inactive participants 2021-01-01 291
2020: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 309
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 297
Total of all active and inactive participants 2020-01-01 297

Measure	Date	Value
2021: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	299
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	0
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	0
Total participants, beginning-of-year	2021-01-01	298
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	290
Number of retired or separated participants receiving benefits	2021-01-01	1
Total of all active and inactive participants	2021-01-01	291
2020: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	309
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	297
Total of all active and inactive participants	2020-01-01	297

Form 5500 Responses for TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN

2021: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Submission has been amended	No
2021-12-01	This submission is the final filing	Yes
2021-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-12-01	Plan is a collectively bargained plan	No
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: TRUDELL HOLDINGS, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 )

Policy contract number

22375

Policy instance

Insurance contract or identification number	22375
Number of Individuals Covered	15
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ERC,INC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

085

Policy instance

Insurance contract or identification number	085
Number of Individuals Covered	303
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $9,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALL SAVERS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82406 )

Policy contract number

5400 34499

Policy instance

Insurance contract or identification number	5400 34499
Number of Individuals Covered	168
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $12,737
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,497,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,737
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-055224

Policy instance

Insurance contract or identification number	010-055224
Number of Individuals Covered	188
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $5,412
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,412
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

S001

Policy instance

Insurance contract or identification number	S001
Number of Individuals Covered	21
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $4,821
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,821
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SHD963459

Policy instance

Insurance contract or identification number	SHD963459
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $18,458
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD, VOLUNTARY LIFE, NEW YORK STATUTORY DISABILITY, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $197,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $18,458
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

97ES001489

Policy instance

Insurance contract or identification number	97ES001489
Number of Individuals Covered	14
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $4,121
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $25,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,035
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00578903

Policy instance

Insurance contract or identification number	00578903
Number of Individuals Covered	104
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $12,367
Total amount of fees paid to insurance company	USD $4,563
Other welfare benefits provided	ACCIDENT, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $61,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,107
Insurance broker organization code?	3
Amount paid for insurance broker fees	4563
Additional information about fees paid to insurance broker	FEES

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT963106

Policy instance

Insurance contract or identification number	VDT963106
Number of Individuals Covered	205
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $4,867
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,867

INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 )

Policy contract number

22375

Policy instance

Insurance contract or identification number	22375
Number of Individuals Covered	15
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX969544

Policy instance

Insurance contract or identification number	FLX969544
Number of Individuals Covered	529
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $2,994
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $2,994
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

97ES001489/97EV

Policy instance

Insurance contract or identification number	97ES001489/97EV
Number of Individuals Covered	14
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $3,916
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $23,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,837
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK970976

Policy instance

Insurance contract or identification number	OK970976
Number of Individuals Covered	358
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $311
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $311
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SHD963459

Policy instance

Insurance contract or identification number	SHD963459
Number of Individuals Covered	174
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-055224

Policy instance

Insurance contract or identification number	010-055224
Number of Individuals Covered	422
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $3,506
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $113,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,506
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00578903

Policy instance

Insurance contract or identification number	00578903
Number of Individuals Covered	116
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $29,280
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $59,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,100
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

776222

Policy instance

Insurance contract or identification number	776222
Number of Individuals Covered	26
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $4,361
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,361
Insurance broker organization code?	3

ERC,INC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

085

Policy instance

Insurance contract or identification number	085
Number of Individuals Covered	304
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $8,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00624382

Policy instance

Insurance contract or identification number	00624382
Number of Individuals Covered	258
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,612
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,184,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	111
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT602456

Policy instance

Insurance contract or identification number	VDT602456
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $461
Total amount of fees paid to insurance company	USD $100
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $461

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

99404531001/2

Policy instance

Insurance contract or identification number	99404531001/2
Number of Individuals Covered	169
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $1,027
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,027
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00624382

Policy instance

Insurance contract or identification number	00624382
Number of Individuals Covered	258
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $4,846
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,176,168
Amount paid for insurance broker fees	5696
Additional information about fees paid to insurance broker	BENEFIT ADVISOR FEES & INCENTIVE COMPENSATION
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

97ES/EV001489

Policy instance

Insurance contract or identification number	97ES/EV001489
Number of Individuals Covered	14
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,359
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $26,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,273
Insurance broker organization code?	3

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK, INC. (National Association of Insurance Commissioners NAIC id number: 37990 )

Policy contract number

D87426-000

Policy instance

Insurance contract or identification number	D87426-000
Number of Individuals Covered	162
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,102
Other welfare benefits provided	NY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $9,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $220
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00578903

Policy instance

Insurance contract or identification number	00578903
Number of Individuals Covered	128
Insurance policy start date	2020-12-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $-1,991
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,939
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
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1087529

Policy instance

Insurance contract or identification number	1087529
Number of Individuals Covered	29
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $726
Total amount of fees paid to insurance company	USD $89
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $726
Amount paid for insurance broker fees	89
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SOK607184

Policy instance

Insurance contract or identification number	SOK607184
Number of Individuals Covered	145
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $139
Total amount of fees paid to insurance company	USD $12
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $139

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM609618

Policy instance

Insurance contract or identification number	SGM609618
Number of Individuals Covered	145
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $1,242
Total amount of fees paid to insurance company	USD $509
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	509
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $1,242

ERC,INC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	319
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $10,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 )

Policy contract number

897487

Policy instance

Insurance contract or identification number	897487
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $263
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS;ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $3,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $218
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-055224

Policy instance

Insurance contract or identification number	010-055224
Number of Individuals Covered	455
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0624382

Policy instance

Insurance contract or identification number	0624382
Number of Individuals Covered	89
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,555
Total amount of fees paid to insurance company	USD $264
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,555
Amount paid for insurance broker fees	264
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

776222

Policy instance

Insurance contract or identification number	776222
Number of Individuals Covered	28
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,809
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,809
Insurance broker organization code?	3

INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 )

Policy contract number

22375

Policy instance

Insurance contract or identification number	22375
Number of Individuals Covered	15
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0638734

Policy instance

Insurance contract or identification number	R0638734
Number of Individuals Covered	14
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011037253

Policy instance

Insurance contract or identification number	0011037253
Number of Individuals Covered	8
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $41
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

R0638734

Policy instance

Insurance contract or identification number	R0638734
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14
Insurance broker organization code?	3

Potentially related plans

TRUDELL HOLDINGS, INC. RETIREMENT AND SAVINGS PLAN [EIN = 882818711]

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Company Name:	TRUDELL HOLDINGS, INC.
Employer identification number (EIN):	752976432
NAIC Classification:	441228
NAIC Description:	Motorcycle, ATV, and All Other Motor Vehicle Dealers