FORT BEND CHRISTIAN ACADEMY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN
401k plan membership statisitcs for FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-09-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-09-01 | 109 |
| Number of retired or separated participants receiving benefits | 2022-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-09-01 | 0 |
| Total of all active and inactive participants | 2022-09-01 | 110 |
| Number of employers contributing to the scheme | 2022-09-01 | 0 |
| 2021: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 102 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 105 |
| Number of employers contributing to the scheme | 2021-09-01 | 0 |
| 2020: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 117 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 118 |
| Number of employers contributing to the scheme | 2020-09-01 | 0 |
| 2019: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 115 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 5 |
| Total of all active and inactive participants | 2019-09-01 | 121 |
| Number of employers contributing to the scheme | 2019-09-01 | 0 |
| 2018: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 93 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 93 |
| Number of employers contributing to the scheme | 2018-09-01 | 0 |
| 2017: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 92 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 92 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 111 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 111 |
| Number of employers contributing to the scheme | 2016-09-01 | 0 |
| 2015: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 121 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 121 |
| Number of employers contributing to the scheme | 2015-09-01 | 0 |
| 2014: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 129 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 129 |
| 2013: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 131 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
| Total of all active and inactive participants | 2013-09-01 | 131 |
| Number of employers contributing to the scheme | 2013-09-01 | 0 |
| 2011: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 92 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
| Total of all active and inactive participants | 2011-09-01 | 92 |
| Number of employers contributing to the scheme | 2011-09-01 | 0 |
| 2010: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 103 |
| Number of retired or separated participants receiving benefits | 2010-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-09-01 | 0 |
| Total of all active and inactive participants | 2010-09-01 | 103 |
| Number of employers contributing to the scheme | 2010-09-01 | 0 |
| 2009: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 95 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-09-01 | 0 |
| Total of all active and inactive participants | 2009-09-01 | 95 |
| Number of employers contributing to the scheme | 2009-09-01 | 0 |
| 2008: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-09-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-09-01 | 102 |
| Number of retired or separated participants receiving benefits | 2008-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-09-01 | 0 |
| Total of all active and inactive participants | 2008-09-01 | 102 |
| Number of employers contributing to the scheme | 2008-09-01 | 0 |
| 2006: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-09-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-09-01 | 99 |
| Number of retired or separated participants receiving benefits | 2006-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-09-01 | 0 |
| Total of all active and inactive participants | 2006-09-01 | 99 |
| Number of employers contributing to the scheme | 2006-09-01 | 0 |
| 2005: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-09-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-09-01 | 102 |
| Number of retired or separated participants receiving benefits | 2005-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-09-01 | 0 |
| Total of all active and inactive participants | 2005-09-01 | 102 |
| Number of employers contributing to the scheme | 2005-09-01 | 0 |
| 2022: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2008 form 5500 responses |
|---|
| 2008-09-01 | Type of plan entity | Single employer plan |
| 2008-09-01 | Plan funding arrangement – Insurance | Yes |
| 2008-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2006 form 5500 responses |
|---|
| 2006-09-01 | Type of plan entity | Single employer plan |
| 2006-09-01 | Plan funding arrangement – Insurance | Yes |
| 2006-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: FORT BEND CHRISTIAN ACADEMY BASIC LIFE/AD&D INSURANCE PLAN 2005 form 5500 responses |
|---|
| 2005-09-01 | Type of plan entity | Single employer plan |
| 2005-09-01 | First time form 5500 has been submitted | Yes |
| 2005-09-01 | Plan funding arrangement – Insurance | Yes |
| 2005-09-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 306456 |
| Policy instance | 2 |
| Insurance contract or identification number | 306456 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $5,959 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $46,512 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,959 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 905747 |
| Policy instance | 1 |
| Insurance contract or identification number | 905747 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $5,632 | | Total amount of fees paid to insurance company | USD $29,103 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM, TELEHEALTH | | Welfare Benefit Premiums Paid to Carrier | USD $617,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,632 | | Amount paid for insurance broker fees | 29103 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 905747 |
| Policy instance | 2 |
| Insurance contract or identification number | 905747 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $12,630 | | Total amount of fees paid to insurance company | USD $29,842 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $639,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,702 | | Amount paid for insurance broker fees | 29842 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804459G |
| Policy instance | 1 |
| Insurance contract or identification number | 804459G | | Number of Individuals Covered | 102 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $4,312 | | Total amount of fees paid to insurance company | USD $746 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $32,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,312 | | Amount paid for insurance broker fees | 746 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 905747 |
| Policy instance | 2 |
| Insurance contract or identification number | 905747 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $244 | | Total amount of fees paid to insurance company | USD $27,284 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $583,532 | | 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 | 27284 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804459G |
| Policy instance | 1 |
| Insurance contract or identification number | 804459G | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $4,097 | | Total amount of fees paid to insurance company | USD $206 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $30,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,097 | | Amount paid for insurance broker fees | 206 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 905747 |
| Policy instance | 2 |
| Insurance contract or identification number | 905747 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $573 | | Total amount of fees paid to insurance company | USD $27,108 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | 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 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $553,463 | | 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 | 27108 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804459G |
| Policy instance | 1 |
| Insurance contract or identification number | 804459G | | Number of Individuals Covered | 106 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $4,037 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $27,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,037 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 905747 |
| Policy instance | 3 |
| Insurance contract or identification number | 905747 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $28,086 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,045 | | 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 | 28086 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT BONUS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 490434 |
| Policy instance | 2 |
| Insurance contract or identification number | 490434 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $4,229 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $48,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,229 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 283743 |
| Policy instance | 1 |
| Insurance contract or identification number | 283743 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $4,838 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $26,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,508 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0283743 |
| Policy instance | 1 |
| Insurance contract or identification number | 0283743 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $4,443 | | Total amount of fees paid to insurance company | USD $578 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $23,950 | | 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 | KM05911399 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05911399 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $1,650 | | Total amount of fees paid to insurance company | USD $247 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,650 | | Amount paid for insurance broker fees | 10 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5383864 |
| Policy instance | 1 |
| Insurance contract or identification number | 5383864 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $2,090 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,090 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | NITSCHE & FERGUSON INS. AGENCY |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5383864 |
| Policy instance | 1 |
| Insurance contract or identification number | 5383864 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $2,001 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,001 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | THE NITSCHE GROUP, INC. |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5383864 |
| Policy instance | 1 |
| Insurance contract or identification number | 5383864 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2009-09-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $1,794 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,794 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | THE NITSCHE GROUP, INC. |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5383864 |
| Policy instance | 1 |
| Insurance contract or identification number | 5383864 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2008-09-01 | | Insurance policy end date | 2009-08-31 | | Total amount of commissions paid to insurance broker | USD $2,594 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,381 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | THE NITSCHE GROUP, INC. |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000817C |
| Policy instance | 1 |
| Insurance contract or identification number | G000817C | | Number of Individuals Covered | 102 | | Insurance policy start date | 2006-09-01 | | Insurance policy end date | 2007-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000817C |
| Policy instance | 1 |
| Insurance contract or identification number | G000817C | | Number of Individuals Covered | 110 | | Insurance policy start date | 2005-09-01 | | Insurance policy end date | 2006-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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