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BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 401k Plan overview

Plan NameBORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT
Plan identification number 502

BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT Benefits

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

401k Sponsoring company profile

BORDERLAND CONSTRUCTION COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:BORDERLAND CONSTRUCTION COMPANY, INC.
Employer identification number (EIN):860323497
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01CJ PRETTYMAN2023-07-19
5022021-01-01CJ PRETTYMAN
5022020-01-01CJ PRETTYMAN2021-09-21
5022019-01-01CJ PRETTYMAN2020-10-01
5022018-01-01
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01C.J. PRETTYMAN C. J. PRETTYMAN2014-07-17
5022012-01-01C.J. PRETTYMAN C. J. PRETTYMAN2013-09-09
5022011-01-01C. J. PRETTYMAN C. J. PRETTYMAN2012-07-30
5022009-01-01C. J. PRETTYMAN C. J. PRETTYMAN2010-07-23

Plan Statistics for BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT

401k plan membership statisitcs for BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT

Measure Date Value
2022: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2022 401k membership
Total participants, beginning-of-year2022-01-01391
Total number of active participants reported on line 7a of the Form 55002022-01-01393
Total of all active and inactive participants2022-01-01393
2021: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2021 401k membership
Total participants, beginning-of-year2021-01-01396
Total number of active participants reported on line 7a of the Form 55002021-01-01391
Total of all active and inactive participants2021-01-01391
2020: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2020 401k membership
Total participants, beginning-of-year2020-01-01396
Total number of active participants reported on line 7a of the Form 55002020-01-01396
Total of all active and inactive participants2020-01-01396
2019: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2019 401k membership
Total participants, beginning-of-year2019-01-01340
Total number of active participants reported on line 7a of the Form 55002019-01-01396
Total of all active and inactive participants2019-01-01396
2018: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2018 401k membership
Total participants, beginning-of-year2018-01-01310
Total number of active participants reported on line 7a of the Form 55002018-01-01340
Total of all active and inactive participants2018-01-01340
2017: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2017 401k membership
Total participants, beginning-of-year2017-01-01292
Total number of active participants reported on line 7a of the Form 55002017-01-01310
Total of all active and inactive participants2017-01-01310
2016: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2016 401k membership
Total participants, beginning-of-year2016-01-01263
Total number of active participants reported on line 7a of the Form 55002016-01-01292
Total of all active and inactive participants2016-01-01292
2015: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2015 401k membership
Total participants, beginning-of-year2015-01-01256
Total number of active participants reported on line 7a of the Form 55002015-01-01263
Total of all active and inactive participants2015-01-01263
2014: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2014 401k membership
Total participants, beginning-of-year2014-01-01233
Total number of active participants reported on line 7a of the Form 55002014-01-01256
Total of all active and inactive participants2014-01-01256
2013: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2013 401k membership
Total participants, beginning-of-year2013-01-01202
Total number of active participants reported on line 7a of the Form 55002013-01-01233
Total of all active and inactive participants2013-01-01233
2012: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2012 401k membership
Total participants, beginning-of-year2012-01-01146
Total number of active participants reported on line 7a of the Form 55002012-01-01202
Total of all active and inactive participants2012-01-01202
2011: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2011 401k membership
Total participants, beginning-of-year2011-01-01228
Total number of active participants reported on line 7a of the Form 55002011-01-01146
Total of all active and inactive participants2011-01-01146
2009: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2009 401k membership
Total participants, beginning-of-year2009-01-01393
Total number of active participants reported on line 7a of the Form 55002009-01-01180
Total of all active and inactive participants2009-01-01180

Form 5500 Responses for BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT

2022: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: BORDERLAND CONSTRUCTION COMPANY, INC. PREMIUM CONVERSION FLEXIBLE BENEFIT 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered294
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,736
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,736
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered393
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $4,502
Total amount of fees paid to insurance companyUSD $1,948
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,502
Amount paid for insurance broker fees1948
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered371
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 $18,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees18360
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered314
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,827
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,827
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered391
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $4,708
Total amount of fees paid to insurance companyUSD $1,961
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,708
Amount paid for insurance broker fees1961
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered390
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 $7,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7629
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered374
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,820
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,820
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered396
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $4,379
Total amount of fees paid to insurance companyUSD $1,704
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,379
Amount paid for insurance broker fees1704
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered288
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,689
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,689
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered275
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,605
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,605
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered396
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $4,467
Total amount of fees paid to insurance companyUSD $1,814
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,467
Amount paid for insurance broker fees1814
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered384
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,899
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,899
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered249
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,519
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,519
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered336
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,829
Total amount of fees paid to insurance companyUSD $704
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,829
Amount paid for insurance broker fees704
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered340
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered226
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,431
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,431
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered283
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,546
Total amount of fees paid to insurance companyUSD $502
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,546
Amount paid for insurance broker fees502
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered310
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered263
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered253
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,466
Total amount of fees paid to insurance companyUSD $584
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,466
Amount paid for insurance broker fees584
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered177
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,248
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,248
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered256
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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: 39616 )
Policy contract number30036618
Policy instance 3
Insurance contract or identification number30036618
Number of Individuals Covered149
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $986
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $986
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered245
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,286
Total amount of fees paid to insurance companyUSD $580
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,286
Amount paid for insurance broker fees580
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-000
Policy instance 1
Insurance contract or identification number16-010302-000
Number of Individuals Covered233
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered239
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,273
Total amount of fees paid to insurance companyUSD $339
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,273
Amount paid for insurance broker fees339
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered187
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,426
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,426
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INSURANCE SVCS INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-00
Policy instance 1
Insurance contract or identification number16-010302-00
Number of Individuals Covered202
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 numberG000AI2M
Policy instance 2
Insurance contract or identification numberG000AI2M
Number of Individuals Covered146
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $987
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-00
Policy instance 1
Insurance contract or identification number16-010302-00
Number of Individuals Covered146
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-010302-00
Policy instance 2
Insurance contract or identification number16-010302-00
Number of Individuals Covered228
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number674294G
Policy instance 1
Insurance contract or identification number674294G
Number of Individuals Covered224
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,533
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,533
Insurance broker organization code?3
Insurance broker nameCBIZ BENEFITS & INS SERVICES

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