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BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 401k Plan overview

Plan NameBRYCON CORPORATION CAFETERIA COMPENSATION PLAN
Plan identification number 501

BRYCON CORPORATION CAFETERIA COMPENSATION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

BRYCON CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:BRYCON CORPORATION
Employer identification number (EIN):850383294
NAIC Classification:236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRYCON CORPORATION CAFETERIA COMPENSATION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-08-01
5012023-08-01CARMELA LITTLE
5012023-08-01CARMELA LITTLE
5012022-08-01
5012022-08-01CARMELA LITTLE
5012021-08-01
5012021-08-01CARMELA LITTLE
5012020-08-01
5012019-08-01
5012017-08-01TRACI METER
5012016-08-01TRACI METER
5012015-08-01TRACI METER
5012014-08-01TRACI METER
5012013-08-01TRACI METER
5012012-08-01PEGGY LEMON
5012011-08-01PEGGY LEMON
5012009-08-01PEGGY LEMON
5012008-08-01PEGGY LEMON
5012007-08-01PEGGY LEMON
5012006-08-01PEGGY LEMON
5012005-08-01PEGGY LEMON
5012004-08-01PEGGY LEMON
5012003-08-01PEGGY LEMON
5012002-08-01PEGGY LEMON

Plan Statistics for BRYCON CORPORATION CAFETERIA COMPENSATION PLAN

401k plan membership statisitcs for BRYCON CORPORATION CAFETERIA COMPENSATION PLAN

Measure Date Value
2023: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2023 401k membership
Total participants, beginning-of-year2023-08-011,015
Total number of active participants reported on line 7a of the Form 55002023-08-011,057
Number of retired or separated participants receiving benefits2023-08-010
Number of other retired or separated participants entitled to future benefits2023-08-010
Total of all active and inactive participants2023-08-011,057
2022: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2022 401k membership
Total participants, beginning-of-year2022-08-01938
Total number of active participants reported on line 7a of the Form 55002022-08-011,015
Number of retired or separated participants receiving benefits2022-08-010
Number of other retired or separated participants entitled to future benefits2022-08-010
Total of all active and inactive participants2022-08-011,015
2021: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01912
Total number of active participants reported on line 7a of the Form 55002021-08-01938
Number of retired or separated participants receiving benefits2021-08-010
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-01938
2020: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01935
Total number of active participants reported on line 7a of the Form 55002020-08-01912
Number of retired or separated participants receiving benefits2020-08-010
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01912
2019: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01840
Total number of active participants reported on line 7a of the Form 55002019-08-01935
Number of retired or separated participants receiving benefits2019-08-010
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01935
2017: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01781
Total number of active participants reported on line 7a of the Form 55002017-08-01811
Number of retired or separated participants receiving benefits2017-08-010
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01811
2016: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01467
Total number of active participants reported on line 7a of the Form 55002016-08-01781
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01781
2015: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01363
Total number of active participants reported on line 7a of the Form 55002015-08-01467
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01467
2014: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01529
Total number of active participants reported on line 7a of the Form 55002014-08-01363
Number of retired or separated participants receiving benefits2014-08-010
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01363
2013: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01621
Total number of active participants reported on line 7a of the Form 55002013-08-01529
Number of retired or separated participants receiving benefits2013-08-010
Number of other retired or separated participants entitled to future benefits2013-08-010
Total of all active and inactive participants2013-08-01529
2012: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01682
Total number of active participants reported on line 7a of the Form 55002012-08-01621
Number of retired or separated participants receiving benefits2012-08-010
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01621
2011: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01548
Total number of active participants reported on line 7a of the Form 55002011-08-01682
Number of retired or separated participants receiving benefits2011-08-010
Number of other retired or separated participants entitled to future benefits2011-08-010
Total of all active and inactive participants2011-08-01682
2009: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01251
Total number of active participants reported on line 7a of the Form 55002009-08-01298
Number of retired or separated participants receiving benefits2009-08-010
Number of other retired or separated participants entitled to future benefits2009-08-010
Total of all active and inactive participants2009-08-01298
2008: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2008 401k membership
Total participants, beginning-of-year2008-08-01239
Total number of active participants reported on line 7a of the Form 55002008-08-01251
Number of retired or separated participants receiving benefits2008-08-010
Number of other retired or separated participants entitled to future benefits2008-08-010
Total of all active and inactive participants2008-08-01251
2007: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2007 401k membership
Total participants, beginning-of-year2007-08-01212
Total number of active participants reported on line 7a of the Form 55002007-08-01239
Number of retired or separated participants receiving benefits2007-08-010
Number of other retired or separated participants entitled to future benefits2007-08-010
Total of all active and inactive participants2007-08-01239
2006: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2006 401k membership
Total participants, beginning-of-year2006-08-01233
Total number of active participants reported on line 7a of the Form 55002006-08-01212
Number of retired or separated participants receiving benefits2006-08-010
Number of other retired or separated participants entitled to future benefits2006-08-010
Total of all active and inactive participants2006-08-01212
2005: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2005 401k membership
Total participants, beginning-of-year2005-08-01185
Total number of active participants reported on line 7a of the Form 55002005-08-01233
Number of retired or separated participants receiving benefits2005-08-010
Number of other retired or separated participants entitled to future benefits2005-08-010
Total of all active and inactive participants2005-08-01233
2004: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2004 401k membership
Total participants, beginning-of-year2004-08-01126
Total number of active participants reported on line 7a of the Form 55002004-08-01185
Number of retired or separated participants receiving benefits2004-08-010
Number of other retired or separated participants entitled to future benefits2004-08-010
Total of all active and inactive participants2004-08-01185
2003: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2003 401k membership
Total participants, beginning-of-year2003-08-01124
Total number of active participants reported on line 7a of the Form 55002003-08-01126
Number of retired or separated participants receiving benefits2003-08-010
Number of other retired or separated participants entitled to future benefits2003-08-010
Total of all active and inactive participants2003-08-01126
2002: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2002 401k membership
Total participants, beginning-of-year2002-08-01124
Total number of active participants reported on line 7a of the Form 55002002-08-01124
Number of retired or separated participants receiving benefits2002-08-010
Number of other retired or separated participants entitled to future benefits2002-08-010
Total of all active and inactive participants2002-08-01124

Form 5500 Responses for BRYCON CORPORATION CAFETERIA COMPENSATION PLAN

2023: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2023 form 5500 responses
2023-08-01Type of plan entitySingle employer plan
2023-08-01Submission has been amendedNo
2023-08-01This submission is the final filingNo
2023-08-01This return/report is a short plan year return/report (less than 12 months)No
2023-08-01Plan is a collectively bargained planNo
2023-08-01Plan funding arrangement – InsuranceYes
2023-08-01Plan funding arrangement – General assets of the sponsorYes
2023-08-01Plan benefit arrangement – InsuranceYes
2023-08-01Plan benefit arrangement – General assets of the sponsorYes
2022: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Submission has been amendedNo
2022-08-01This submission is the final filingNo
2022-08-01This return/report is a short plan year return/report (less than 12 months)No
2022-08-01Plan is a collectively bargained planNo
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – General assets of the sponsorYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – General assets of the sponsorYes
2021: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Submission has been amendedNo
2021-08-01This submission is the final filingNo
2021-08-01This return/report is a short plan year return/report (less than 12 months)No
2021-08-01Plan is a collectively bargained planNo
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – InsuranceYes
2020: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Submission has been amendedNo
2020-08-01This submission is the final filingNo
2020-08-01This return/report is a short plan year return/report (less than 12 months)No
2020-08-01Plan is a collectively bargained planNo
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – InsuranceYes
2019: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Submission has been amendedNo
2019-08-01This submission is the final filingNo
2019-08-01This return/report is a short plan year return/report (less than 12 months)No
2019-08-01Plan is a collectively bargained planNo
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – InsuranceYes
2017: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedNo
2017-08-01This submission is the final filingNo
2017-08-01This return/report is a short plan year return/report (less than 12 months)No
2017-08-01Plan is a collectively bargained planNo
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes
2008: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2008 form 5500 responses
2008-08-01Type of plan entitySingle employer plan
2008-08-01Submission has been amendedNo
2008-08-01This submission is the final filingNo
2008-08-01This return/report is a short plan year return/report (less than 12 months)No
2008-08-01Plan is a collectively bargained planNo
2008-08-01Plan funding arrangement – InsuranceYes
2008-08-01Plan benefit arrangement – InsuranceYes
2007: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2007 form 5500 responses
2007-08-01Type of plan entitySingle employer plan
2007-08-01Submission has been amendedNo
2007-08-01This submission is the final filingNo
2007-08-01This return/report is a short plan year return/report (less than 12 months)No
2007-08-01Plan is a collectively bargained planNo
2007-08-01Plan funding arrangement – InsuranceYes
2007-08-01Plan benefit arrangement – InsuranceYes
2006: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2006 form 5500 responses
2006-08-01Type of plan entitySingle employer plan
2006-08-01Submission has been amendedNo
2006-08-01This submission is the final filingNo
2006-08-01This return/report is a short plan year return/report (less than 12 months)No
2006-08-01Plan is a collectively bargained planNo
2006-08-01Plan funding arrangement – InsuranceYes
2006-08-01Plan benefit arrangement – InsuranceYes
2005: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2005 form 5500 responses
2005-08-01Type of plan entitySingle employer plan
2005-08-01Submission has been amendedNo
2005-08-01This submission is the final filingNo
2005-08-01This return/report is a short plan year return/report (less than 12 months)No
2005-08-01Plan is a collectively bargained planNo
2005-08-01Plan funding arrangement – InsuranceYes
2005-08-01Plan benefit arrangement – InsuranceYes
2004: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2004 form 5500 responses
2004-08-01Type of plan entitySingle employer plan
2004-08-01Submission has been amendedNo
2004-08-01This submission is the final filingNo
2004-08-01This return/report is a short plan year return/report (less than 12 months)No
2004-08-01Plan is a collectively bargained planNo
2004-08-01Plan funding arrangement – InsuranceYes
2004-08-01Plan benefit arrangement – InsuranceYes
2003: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2003 form 5500 responses
2003-08-01Type of plan entitySingle employer plan
2003-08-01Submission has been amendedNo
2003-08-01This submission is the final filingNo
2003-08-01This return/report is a short plan year return/report (less than 12 months)No
2003-08-01Plan is a collectively bargained planNo
2003-08-01Plan funding arrangement – InsuranceYes
2003-08-01Plan benefit arrangement – InsuranceYes
2002: BRYCON CORPORATION CAFETERIA COMPENSATION PLAN 2002 form 5500 responses
2002-08-01Type of plan entitySingle employer plan
2002-08-01Submission has been amendedNo
2002-08-01This submission is the final filingNo
2002-08-01This return/report is a short plan year return/report (less than 12 months)No
2002-08-01Plan is a collectively bargained planNo
2002-08-01Plan funding arrangement – InsuranceYes
2002-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 7
Insurance contract or identification numberG000BWN3
Number of Individuals Covered45
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $2,676
Total amount of fees paid to insurance companyUSD $754
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 BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D VOLUNTARY
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 $19,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 1
Insurance contract or identification numberG000BWN3
Number of Individuals Covered174
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $4,656
Total amount of fees paid to insurance companyUSD $2,195
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $71,201
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: 32395 )
Policy contract number12204559
Policy instance 2
Insurance contract or identification number12204559
Number of Individuals Covered497
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $2,537
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 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 $67,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )
Policy contract number0008567
Policy instance 3
Insurance contract or identification number0008567
Number of Individuals Covered1057
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $18,441
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number110914
Policy instance 4
Insurance contract or identification number110914
Number of Individuals Covered1045
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $214,170
Total amount of fees paid to insurance companyUSD $4,023
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 $1,342,489
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 numberG000BWN3
Policy instance 5
Insurance contract or identification numberG000BWN3
Number of Individuals Covered506
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $5,674
Total amount of fees paid to insurance companyUSD $4,452
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 BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $154,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 6
Insurance contract or identification numberG000BWN3
Number of Individuals Covered173
Insurance policy start date2023-08-01
Insurance policy end date2024-07-31
Total amount of commissions paid to insurance brokerUSD $4,306
Total amount of fees paid to insurance companyUSD $2,050
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 BenefitNo
Temporary Disability Insurance Welfare BenefitYes
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 $67,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 7
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 6
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 5
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number110914
Policy instance 4
DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )
Policy contract number0008567
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12204559
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12204559
Policy instance 2
DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )
Policy contract number1220
Policy instance 3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number110914
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 6
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BWN3
Policy instance 7
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number110914
Policy instance 4
DELTA DENTAL OF NEW MEXICO (National Association of Insurance Commissioners NAIC id number: 47287 )
Policy contract number1220
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number12204559
Policy instance 2
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number687662G/698870G
Policy instance 1

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