ARIZONA MATERIALS, LLC has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: ARIZONA MATERIALS LLC 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 306 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 306 |
| Total of all active and inactive participants | 2022-02-01 | 306 |
| Total participants | 2022-02-01 | 306 |
| 2021: ARIZONA MATERIALS LLC 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 305 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 306 |
| Total of all active and inactive participants | 2021-02-01 | 306 |
| Total participants | 2021-02-01 | 306 |
| 2020: ARIZONA MATERIALS LLC 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 319 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 305 |
| Total of all active and inactive participants | 2020-02-01 | 305 |
| Total participants | 2020-02-01 | 305 |
| 2019: ARIZONA MATERIALS LLC 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 270 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 305 |
| Total of all active and inactive participants | 2019-02-01 | 305 |
| Total participants | 2019-02-01 | 305 |
| Number of participants with account balances | 2019-02-01 | 0 |
| 2018: ARIZONA MATERIALS LLC 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 247 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 270 |
| Total of all active and inactive participants | 2018-02-01 | 270 |
| Total participants | 2018-02-01 | 270 |
| 2017: ARIZONA MATERIALS LLC 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 247 |
| Total of all active and inactive participants | 2017-02-01 | 247 |
| Total participants | 2017-02-01 | 247 |
| 2016: ARIZONA MATERIALS LLC 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 247 |
| Total of all active and inactive participants | 2016-02-01 | 247 |
| Total participants | 2016-02-01 | 247 |
| 2015: ARIZONA MATERIALS LLC 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 240 |
| Total of all active and inactive participants | 2015-02-01 | 240 |
| Total participants | 2015-02-01 | 0 |
| 2014: ARIZONA MATERIALS LLC 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 233 |
| Total of all active and inactive participants | 2014-02-01 | 233 |
| Total participants | 2014-02-01 | 0 |
| 2013: ARIZONA MATERIALS LLC 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 196 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 230 |
| Total of all active and inactive participants | 2013-02-01 | 230 |
| Total participants | 2013-02-01 | 0 |
| 2012: ARIZONA MATERIALS LLC 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 196 |
| Total of all active and inactive participants | 2012-02-01 | 196 |
| Total participants | 2012-02-01 | 0 |
| 2011: ARIZONA MATERIALS LLC 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 153 |
| Total of all active and inactive participants | 2011-02-01 | 153 |
| Total participants | 2011-02-01 | 153 |
| 2009: ARIZONA MATERIALS LLC 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 116 |
| Total of all active and inactive participants | 2009-02-01 | 116 |
| Total participants | 2009-02-01 | 116 |
| 2022: ARIZONA MATERIALS LLC 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 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: ARIZONA MATERIALS LLC 2021 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2020 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2019 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2018 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2017 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2016 form 5500 responses |
|---|
| 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: ARIZONA MATERIALS LLC 2015 form 5500 responses |
|---|
| 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 |
| 2014: ARIZONA MATERIALS LLC 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: ARIZONA MATERIALS LLC 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: ARIZONA MATERIALS LLC 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: ARIZONA MATERIALS LLC 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: ARIZONA MATERIALS LLC 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5943140 |
| Policy instance | 4 |
| Insurance contract or identification number | 5943140 | | Number of Individuals Covered | 986 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $17,290 | | Total amount of fees paid to insurance company | USD $255 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $343,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,290 | | Amount paid for insurance broker fees | 255 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 3 |
| Insurance contract or identification number | 10115476 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $33,951 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $226,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,951 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115475 |
| Policy instance | 2 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $4,881 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,881 | | Additional information about fees paid to insurance broker | LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 038959 |
| Policy instance | 1 |
| Insurance contract or identification number | 038959 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $70,920 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $652,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,920 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 038959 |
| Policy instance | 1 |
| Insurance contract or identification number | 038959 | | Number of Individuals Covered | 606 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $70,360 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $562,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,360 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115475 |
| Policy instance | 2 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $4,881 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,881 | | Additional information about fees paid to insurance broker | LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 3 |
| Insurance contract or identification number | 10115476 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $32,715 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WEEKLY INCOME | | Welfare Benefit Premiums Paid to Carrier | USD $218,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,715 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5943140 |
| Policy instance | 4 |
| Insurance contract or identification number | 5943140 | | Number of Individuals Covered | 953 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $16,705 | | Total amount of fees paid to insurance company | USD $4,733 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $317,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,705 | | Amount paid for insurance broker fees | 4733 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $7,159 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Welfare Benefit Premiums Paid to Carrier | USD $2,098 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7159 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker organization code? | 5 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 038959 |
| Policy instance | 2 |
| Insurance contract or identification number | 038959 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $6,086 | | Total amount of fees paid to insurance company | USD $66,900 | | Welfare Benefit Premiums Paid to Carrier | USD $507,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 66900 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $6,086 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115476 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $29,733 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $198,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,733 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115475 |
| Policy instance | 3 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $4,806 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,806 | | Additional information about fees paid to insurance broker | LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | S5011 |
| Policy instance | 5 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,360 | | 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 number | 5943140 |
| Policy instance | 6 |
| Insurance contract or identification number | 5943140 | | Number of Individuals Covered | 996 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,789 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $329,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,789 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,464 | | Total amount of fees paid to insurance company | USD $78,464 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 78463 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $2,464 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | 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 number | 10115475 |
| Policy instance | 3 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $4,683 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,683 | | Additional information about fees paid to insurance broker | LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115476 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $27,296 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,296 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | S5011 |
| Policy instance | 5 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $64,180 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,180 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05943140 |
| Policy instance | 6 |
| Insurance contract or identification number | KM05943140 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $2,465 | | Total amount of fees paid to insurance company | USD $1 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,465 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | BROKER COMMISSION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05943140 |
| Policy instance | 6 |
| Insurance contract or identification number | KM05943140 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | S5011 |
| Policy instance | 5 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of fees paid to insurance company | USD $19,492 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 19492 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | ARIZONA BENEFITS CONSULTANTS, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115476 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2016-03-01 | | Insurance policy end date | 2017-02-28 | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 number | 10115475 |
| Policy instance | 3 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2016-03-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $29,444 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,826 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 | | Insurance broker name | POWERS LEAVITT INSURANCE |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of fees paid to insurance company | USD $38,428 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 38428 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | DENNY MOLLIHAN INC. |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 3 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | 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 number | 10115475 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $28,215 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,273 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 | | Insurance broker name | POWERS LEAVITT INSURANCE |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115476 |
| Policy instance | 5 |
| Insurance contract or identification number | 10115476 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of fees paid to insurance company | USD $118,879 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 61982 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker organization code? | 5 | | Insurance broker name | DENNY MOLLIHAN INC. |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | 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 number | 10115475 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $20,539 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,556 | | Additional information about fees paid to insurance broker | SHORT-TERM DISABILITY | | Insurance broker organization code? | 3 | | Insurance broker name | POWERS LEAVITT INSURANCE |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of fees paid to insurance company | USD $121,137 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 63016 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker organization code? | 5 | | Insurance broker name | DENNY MOLLIHAN INC. |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 3 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | S5011 |
| Policy instance | 1 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of fees paid to insurance company | USD $103,762 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 57210 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker organization code? | 5 | | Insurance broker name | DENNY MOLLIHAN INC. |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 3 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | 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 number | 10115475 |
| Policy instance | 4 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of fees paid to insurance company | USD $3,815 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3815 | | Insurance broker organization code? | 3 | | Insurance broker name | POWERS LEAVITT INSURANCE |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10115475 |
| Policy instance | 1 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $3,075 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,075 | | Insurance broker organization code? | 3 | | Insurance broker name | POWERS LEAVITT INSURANCE |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | S5011 |
| Policy instance | 4 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $34,154 | | Total amount of fees paid to insurance company | USD $42,820 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,154 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 42820 | | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATION | | Insurance broker name | GILSBAR, INC. |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 3 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | S5011 |
| Policy instance | 4 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $26,144 | | Total amount of fees paid to insurance company | USD $31,659 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | S5011 |
| Policy instance | 3 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Other welfare benefits provided | CONTRACT ADMINISTRATION | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | S5011 |
| Policy instance | 2 |
| Insurance contract or identification number | S5011 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | 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 number | 10115475 |
| Policy instance | 1 |
| Insurance contract or identification number | 10115475 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $2,761 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
