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WILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN 401k Plan overview

Plan NameWILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN
Plan identification number 501

WILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    WILDFLOWER BREAD COMPANY, LLC has sponsored the creation of one or more 401k plans.

    Company Name:WILDFLOWER BREAD COMPANY, LLC
    Employer identification number (EIN):800829894
    NAIC Classification:722513
    NAIC Description:Limited-Service Restaurants

    Additional information about WILDFLOWER BREAD COMPANY, LLC

    Jurisdiction of Incorporation: State of Delaware Division of Corporations
    Incorporation Date:
    Company Identification Number: 5173757

    More information about WILDFLOWER BREAD COMPANY, LLC

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan WILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-06-01
    5012018-06-01
    5012017-06-01CHERYL CAMPBELL CHERYL CAMPBELL2018-12-19
    5012017-05-01CHERYL CAMPBELL
    5012016-05-01CHERYL CAMPBELL
    5012015-05-01CHERYL CAMPBELL
    5012014-05-01CHERYL CAMPBELL
    5012013-05-01CHERYL CAMPBELL
    5012012-05-01CHERYL CAMPBELL
    5012011-05-01CHERYL CAMPBELL
    5012010-05-01CHERYL CAMPBELL
    5012009-05-01CHERYL CAMPBELL

    Plan Statistics for WILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN

    401k plan membership statisitcs for WILDFLOWER BREAD COMPANY WELFARE BENEFITS PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-06-01167
    Total number of active participants reported on line 7a of the Form 55002019-06-0173
    Number of retired or separated participants receiving benefits2019-06-014
    Number of other retired or separated participants entitled to future benefits2019-06-010
    Total of all active and inactive participants2019-06-0177
    2018
    Total participants, beginning-of-year2018-06-01194
    Total number of active participants reported on line 7a of the Form 55002018-06-01165
    Number of retired or separated participants receiving benefits2018-06-012
    Number of other retired or separated participants entitled to future benefits2018-06-010
    Total of all active and inactive participants2018-06-01167
    2017
    Total participants, beginning-of-year2017-06-01175
    Total number of active participants reported on line 7a of the Form 55002017-06-01193
    Number of retired or separated participants receiving benefits2017-06-011
    Number of other retired or separated participants entitled to future benefits2017-06-010
    Total of all active and inactive participants2017-06-01194
    Total participants, beginning-of-year2017-05-01175
    Total number of active participants reported on line 7a of the Form 55002017-05-01171
    Number of retired or separated participants receiving benefits2017-05-014
    Number of other retired or separated participants entitled to future benefits2017-05-010
    Total of all active and inactive participants2017-05-01175
    2016
    Total participants, beginning-of-year2016-05-01158
    Total number of active participants reported on line 7a of the Form 55002016-05-01171
    Number of retired or separated participants receiving benefits2016-05-014
    Number of other retired or separated participants entitled to future benefits2016-05-010
    Total of all active and inactive participants2016-05-01175
    2015
    Total participants, beginning-of-year2015-05-01155
    Total number of active participants reported on line 7a of the Form 55002015-05-01155
    Number of retired or separated participants receiving benefits2015-05-013
    Number of other retired or separated participants entitled to future benefits2015-05-010
    Total of all active and inactive participants2015-05-01158
    2014
    Total participants, beginning-of-year2014-05-01175
    Total number of active participants reported on line 7a of the Form 55002014-05-01187
    Number of retired or separated participants receiving benefits2014-05-010
    Number of other retired or separated participants entitled to future benefits2014-05-010
    Total of all active and inactive participants2014-05-01187
    2013
    Total participants, beginning-of-year2013-05-01108
    Total number of active participants reported on line 7a of the Form 55002013-05-01175
    Number of retired or separated participants receiving benefits2013-05-010
    Number of other retired or separated participants entitled to future benefits2013-05-010
    Total of all active and inactive participants2013-05-01175
    2012
    Total participants, beginning-of-year2012-05-01108
    Total number of active participants reported on line 7a of the Form 55002012-05-01108
    Number of retired or separated participants receiving benefits2012-05-010
    Number of other retired or separated participants entitled to future benefits2012-05-010
    Total of all active and inactive participants2012-05-01108
    Total participants2012-05-01108
    2011
    Total participants, beginning-of-year2011-05-01117
    Total number of active participants reported on line 7a of the Form 55002011-05-01108
    Number of retired or separated participants receiving benefits2011-05-010
    Number of other retired or separated participants entitled to future benefits2011-05-010
    Total of all active and inactive participants2011-05-01108
    Total participants2011-05-01108
    2010
    Total participants, beginning-of-year2010-05-01101
    Total number of active participants reported on line 7a of the Form 55002010-05-01117
    Number of retired or separated participants receiving benefits2010-05-010
    Number of other retired or separated participants entitled to future benefits2010-05-010
    Total of all active and inactive participants2010-05-01117
    Total participants2010-05-01117
    2009
    Total participants, beginning-of-year2009-05-01100
    Total number of active participants reported on line 7a of the Form 55002009-05-01101
    Number of retired or separated participants receiving benefits2009-05-010
    Number of other retired or separated participants entitled to future benefits2009-05-010
    Total of all active and inactive participants2009-05-01101
    Total participants2009-05-01101

    Form 5500 Responses

    2019
    2019-06-01Type of plan entitySingle employer plan
    2019-06-01Submission has been amendedNo
    2019-06-01This submission is the final filingNo
    2019-06-01This return/report is a short plan year return/report (less than 12 months)No
    2019-06-01Plan is a collectively bargained planNo
    2019-06-01Plan funding arrangement – General assets of the sponsorYes
    2019-06-01Plan benefit arrangement – InsuranceYes
    2019-06-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-06-01Type of plan entitySingle employer plan
    2018-06-01Submission has been amendedNo
    2018-06-01This submission is the final filingNo
    2018-06-01This return/report is a short plan year return/report (less than 12 months)No
    2018-06-01Plan is a collectively bargained planNo
    2018-06-01Plan funding arrangement – General assets of the sponsorYes
    2018-06-01Plan benefit arrangement – InsuranceYes
    2018-06-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-06-01Type of plan entitySingle employer plan
    2017-06-01Submission has been amendedNo
    2017-06-01This submission is the final filingNo
    2017-06-01This return/report is a short plan year return/report (less than 12 months)No
    2017-06-01Plan is a collectively bargained planNo
    2017-06-01Plan funding arrangement – General assets of the sponsorYes
    2017-06-01Plan benefit arrangement – InsuranceYes
    2017-06-01Plan benefit arrangement – General assets of the sponsorYes
    2017-05-01Type of plan entitySingle employer plan
    2017-05-01Submission has been amendedNo
    2017-05-01This submission is the final filingNo
    2017-05-01This return/report is a short plan year return/report (less than 12 months)Yes
    2017-05-01Plan is a collectively bargained planNo
    2017-05-01Plan funding arrangement – General assets of the sponsorYes
    2017-05-01Plan benefit arrangement – InsuranceYes
    2017-05-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-05-01Type of plan entitySingle employer plan
    2016-05-01Submission has been amendedNo
    2016-05-01This submission is the final filingNo
    2016-05-01This return/report is a short plan year return/report (less than 12 months)No
    2016-05-01Plan is a collectively bargained planNo
    2016-05-01Plan funding arrangement – General assets of the sponsorYes
    2016-05-01Plan benefit arrangement – InsuranceYes
    2016-05-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-05-01Type of plan entitySingle employer plan
    2015-05-01Submission has been amendedNo
    2015-05-01This submission is the final filingNo
    2015-05-01This return/report is a short plan year return/report (less than 12 months)No
    2015-05-01Plan is a collectively bargained planNo
    2015-05-01Plan funding arrangement – General assets of the sponsorYes
    2015-05-01Plan benefit arrangement – InsuranceYes
    2015-05-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-05-01Type of plan entitySingle employer plan
    2014-05-01Submission has been amendedNo
    2014-05-01This submission is the final filingNo
    2014-05-01This return/report is a short plan year return/report (less than 12 months)No
    2014-05-01Plan is a collectively bargained planNo
    2014-05-01Plan funding arrangement – General assets of the sponsorYes
    2014-05-01Plan benefit arrangement – InsuranceYes
    2014-05-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-05-01Type of plan entitySingle employer plan
    2013-05-01Submission has been amendedNo
    2013-05-01This submission is the final filingNo
    2013-05-01This return/report is a short plan year return/report (less than 12 months)No
    2013-05-01Plan is a collectively bargained planNo
    2013-05-01Plan funding arrangement – General assets of the sponsorYes
    2013-05-01Plan benefit arrangement – InsuranceYes
    2013-05-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-05-01Type of plan entitySingle employer plan
    2012-05-01Submission has been amendedNo
    2012-05-01This submission is the final filingNo
    2012-05-01This return/report is a short plan year return/report (less than 12 months)No
    2012-05-01Plan is a collectively bargained planNo
    2012-05-01Plan funding arrangement – General assets of the sponsorYes
    2012-05-01Plan benefit arrangement – InsuranceYes
    2012-05-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-05-01Type of plan entitySingle employer plan
    2011-05-01Submission has been amendedNo
    2011-05-01This submission is the final filingNo
    2011-05-01This return/report is a short plan year return/report (less than 12 months)No
    2011-05-01Plan is a collectively bargained planNo
    2011-05-01Plan funding arrangement – General assets of the sponsorYes
    2011-05-01Plan benefit arrangement – InsuranceYes
    2011-05-01Plan benefit arrangement – General assets of the sponsorYes
    2010
    2010-05-01Type of plan entitySingle employer plan
    2010-05-01Submission has been amendedNo
    2010-05-01This submission is the final filingNo
    2010-05-01This return/report is a short plan year return/report (less than 12 months)No
    2010-05-01Plan is a collectively bargained planNo
    2010-05-01Plan funding arrangement – General assets of the sponsorYes
    2010-05-01Plan benefit arrangement – InsuranceYes
    2010-05-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-05-01Type of plan entitySingle employer plan
    2009-05-01First time form 5500 has been submittedYes
    2009-05-01Submission has been amendedNo
    2009-05-01This submission is the final filingNo
    2009-05-01This return/report is a short plan year return/report (less than 12 months)No
    2009-05-01Plan is a collectively bargained planNo
    2009-05-01Plan funding arrangement – General assets of the sponsorYes
    2009-05-01Plan benefit arrangement – InsuranceYes
    2009-05-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number911296
    Policy instance 5
    Insurance contract or identification number911296
    Number of Individuals Covered165
    Insurance policy start date2019-06-01
    Insurance policy end date2020-05-31
    Total amount of commissions paid to insurance brokerUSD $4,572
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $42,350
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,572
    Insurance broker organization code?3
    AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 )
    Policy contract number8351329
    Policy instance 4
    Insurance contract or identification number8351329
    Number of Individuals Covered9
    Insurance policy start date2019-06-01
    Insurance policy end date2020-05-31
    Total amount of commissions paid to insurance brokerUSD $10,226
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $91,729
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,226
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number305066
    Policy instance 3
    Insurance contract or identification number305066
    Number of Individuals Covered63
    Insurance policy start date2019-06-01
    Insurance policy end date2020-05-31
    Total amount of commissions paid to insurance brokerUSD $1,290
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $11,219
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,290
    Insurance broker organization code?3
    TOTAL DENTAL ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52120 )
    Policy contract number652150
    Policy instance 2
    Insurance contract or identification number652150
    Number of Individuals Covered17
    Insurance policy start date2019-06-01
    Insurance policy end date2020-05-31
    Total amount of commissions paid to insurance brokerUSD $2,001
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $33,354
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,001
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
    Policy contract number31567
    Policy instance 1
    Insurance contract or identification number31567
    Number of Individuals Covered57
    Insurance policy start date2019-06-01
    Insurance policy end date2020-05-31
    Total amount of commissions paid to insurance brokerUSD $28,777
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $135,881
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $28,777
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number911296
    Policy instance 5
    Insurance contract or identification number911296
    Number of Individuals Covered311
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    Total amount of commissions paid to insurance brokerUSD $5,110
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $51,171
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,110
    Insurance broker organization code?3
    TOTAL DENTAL ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52120 )
    Policy contract number652150
    Policy instance 4
    Insurance contract or identification number652150
    Number of Individuals Covered195
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    Total amount of commissions paid to insurance brokerUSD $1,985
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $27,560
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,985
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number305066
    Policy instance 3
    Insurance contract or identification number305066
    Number of Individuals Covered49
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    Total amount of commissions paid to insurance brokerUSD $2,322
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $16,121
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,322
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
    Policy contract number31567
    Policy instance 2
    Insurance contract or identification number31567
    Number of Individuals Covered113
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    Total amount of commissions paid to insurance brokerUSD $34,761
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $143,010
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $34,761
    Insurance broker organization code?3
    AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 )
    Policy contract number8351329
    Policy instance 1
    Insurance contract or identification number8351329
    Number of Individuals Covered102
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    Total amount of commissions paid to insurance brokerUSD $10,119
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $102,145
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,119
    Insurance broker organization code?3
    AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 )
    Policy contract number8351329
    Policy instance 4
    Insurance contract or identification number8351329
    Number of Individuals Covered106
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    Total amount of commissions paid to insurance brokerUSD $7,036
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $73,475
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,036
    Insurance broker organization code?3
    Insurance broker nameJP GRIFFIN COMPANIES LLC
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number305066
    Policy instance 3
    Insurance contract or identification number305066
    Number of Individuals Covered73
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    Total amount of commissions paid to insurance brokerUSD $1,998
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $17,874
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,998
    Insurance broker organization code?3
    Insurance broker nameJP GRIFFIN COMPANIES, LLC
    TOTAL DENTAL ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52120 )
    Policy contract number652150
    Policy instance 2
    Insurance contract or identification number652150
    Number of Individuals Covered145
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    Total amount of commissions paid to insurance brokerUSD $1,128
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $24,891
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,128
    Insurance broker organization code?3
    Insurance broker nameJP GRIFFIN COMPANIES
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number911296
    Policy instance 1
    Insurance contract or identification number911296
    Number of Individuals Covered265
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    Total amount of commissions paid to insurance brokerUSD $4,785
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $52,218
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,785
    Insurance broker organization code?3
    Insurance broker nameJP GRIFFIN COMPANIES LLC

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