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VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 401k Plan overview

Plan NameVIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN
Plan identification number 501

VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

VIGILANT MANUFACTURERS TRUST OF ARIZONA has sponsored the creation of one or more 401k plans.

Company Name:VIGILANT MANUFACTURERS TRUST OF ARIZONA
Employer identification number (EIN):832492019
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01

Plan Statistics for VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN

401k plan membership statisitcs for VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN

Measure Date Value
2022: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01251
Total number of active participants reported on line 7a of the Form 55002022-01-01314
Total of all active and inactive participants2022-01-01314
2021: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01235
Total number of active participants reported on line 7a of the Form 55002021-01-01251
Total of all active and inactive participants2021-01-01251
2020: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01152
Total number of active participants reported on line 7a of the Form 55002020-01-01235
Total of all active and inactive participants2020-01-01235
2019: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-010
Total number of active participants reported on line 7a of the Form 55002019-01-01152
Total of all active and inactive participants2019-01-01152

Financial Data on VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN

Measure Date Value
2022 : VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$54,889
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$97,756
Total income from all sources (including contributions)2022-12-31$2,290,270
Total of all expenses incurred2022-12-31$2,310,829
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$2,037,734
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,288,447
Value of total assets at end of year2022-12-31$35,613
Value of total assets at beginning of year2022-12-31$99,039
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$273,095
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$204,645
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$100,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$4,961
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$916
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$576
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$383
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$49,537
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$86,181
Other income not declared elsewhere2022-12-31$1,823
Administrative expenses (other) incurred2022-12-31$5,415
Liabilities. Value of operating payables at end of year2022-12-31$4,898
Liabilities. Value of operating payables at beginning of year2022-12-31$9,500
Total non interest bearing cash at end of year2022-12-31$33,719
Total non interest bearing cash at beginning of year2022-12-31$95,078
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-20,559
Value of net assets at end of year (total assets less liabilities)2022-12-31$-19,276
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,283
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$2,037,734
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$2,283,486
Employer contributions (assets) at end of year2022-12-31$1,318
Employer contributions (assets) at beginning of year2022-12-31$2,662
Contract administrator fees2022-12-31$63,035
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$454
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$2,075
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2022-12-31910614823
2021 : VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$97,756
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$69,462
Total income from all sources (including contributions)2021-12-31$2,065,305
Total of all expenses incurred2021-12-31$2,065,673
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,818,079
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,063,044
Value of total assets at end of year2021-12-31$99,039
Value of total assets at beginning of year2021-12-31$71,113
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$247,594
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$185,885
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$100,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$4,733
Participant contributions at end of year2021-12-31$916
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$383
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$461
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$86,181
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$50,233
Other income not declared elsewhere2021-12-31$2,261
Administrative expenses (other) incurred2021-12-31$5,066
Liabilities. Value of operating payables at end of year2021-12-31$9,500
Liabilities. Value of operating payables at beginning of year2021-12-31$3,729
Total non interest bearing cash at end of year2021-12-31$95,078
Total non interest bearing cash at beginning of year2021-12-31$55,488
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-368
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,283
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,651
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$1,818,079
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,058,311
Employer contributions (assets) at end of year2021-12-31$2,662
Employer contributions (assets) at beginning of year2021-12-31$15,164
Contract administrator fees2021-12-31$56,643
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$2,075
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$15,500
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2021-12-31910614823
2020 : VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$69,462
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$96,334
Total income from all sources (including contributions)2020-12-31$1,522,011
Total of all expenses incurred2020-12-31$1,520,954
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,348,389
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,519,788
Value of total assets at end of year2020-12-31$71,113
Value of total assets at beginning of year2020-12-31$96,928
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$172,565
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$125,836
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$100,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$461
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$272
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$50,233
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$68,233
Other income not declared elsewhere2020-12-31$2,223
Administrative expenses (other) incurred2020-12-31$4,984
Liabilities. Value of operating payables at end of year2020-12-31$3,729
Liabilities. Value of operating payables at beginning of year2020-12-31$22,262
Total non interest bearing cash at end of year2020-12-31$55,488
Total non interest bearing cash at beginning of year2020-12-31$96,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,057
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,651
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$594
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,348,389
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,519,788
Employer contributions (assets) at end of year2020-12-31$15,164
Employer contributions (assets) at beginning of year2020-12-31$324
Contract administrator fees2020-12-31$41,745
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$15,500
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$5,839
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2020-12-31910614823
2019 : VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$96,334
Total income from all sources (including contributions)2019-12-31$544,836
Total of all expenses incurred2019-12-31$544,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$483,804
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$542,858
Value of total assets at end of year2019-12-31$96,928
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$60,438
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$43,083
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$100,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$645
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$272
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$68,233
Other income not declared elsewhere2019-12-31$1,978
Administrative expenses (other) incurred2019-12-31$2,403
Liabilities. Value of operating payables at end of year2019-12-31$22,262
Total non interest bearing cash at end of year2019-12-31$96,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$594
Value of net assets at end of year (total assets less liabilities)2019-12-31$594
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$483,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$542,213
Employer contributions (assets) at end of year2019-12-31$324
Contract administrator fees2019-12-31$14,952
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$5,839
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2019-12-31910614823

Form 5500 Responses for VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN

2022: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: VIGILANT MANUFACTURERS TRUST OF ARIZONA PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number011728
Policy instance 4
Insurance contract or identification number011728
Number of Individuals Covered379
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $286
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees286
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757764
Policy instance 3
Insurance contract or identification number757764
Number of Individuals Covered100
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30044146
Policy instance 2
Insurance contract or identification number30044146
Number of Individuals Covered84
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,649
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 number051001-020
Policy instance 1
Insurance contract or identification number051001-020
Number of Individuals Covered420
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,018,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757764
Policy instance 3
Insurance contract or identification number757764
Number of Individuals Covered160
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $305
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $11,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $305
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30044146
Policy instance 2
Insurance contract or identification number30044146
Number of Individuals Covered120
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,820
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 number051000-017
Policy instance 1
Insurance contract or identification number051000-017
Number of Individuals Covered445
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $350
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,799,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees250
Additional information about fees paid to insurance brokerSPECIAL INCENTIVE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757764
Policy instance 3
Insurance contract or identification number757764
Number of Individuals Covered160
Insurance policy start date2020-10-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30044146
Policy instance 2
Insurance contract or identification number30044146
Number of Individuals Covered80
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,161
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 number051000-014
Policy instance 1
Insurance contract or identification number051000-014
Number of Individuals Covered229
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $150
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,336,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees150
Additional information about fees paid to insurance brokerSPECIAL INCENTIVE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757764
Policy instance 3
Insurance contract or identification number757764
Number of Individuals Covered66
Insurance policy start date2019-10-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30044146
Policy instance 2
Insurance contract or identification number30044146
Number of Individuals Covered22
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $682
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 number051000-008
Policy instance 1
Insurance contract or identification number051000-008
Number of Individuals Covered142
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $482,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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