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GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 401k Plan overview

Plan NameGROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY
Plan identification number 501

GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 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
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

EARNHARDT MANAGEMENT COMPANY has sponsored the creation of one or more 401k plans.

Company Name:EARNHARDT MANAGEMENT COMPANY
Employer identification number (EIN):860394615
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01HAL J EARNHARDT III2023-03-23
5012020-10-01HAL J. EARNHARDT, III2022-05-11
5012019-10-01HAL J. EARNHARDT III2021-04-27
5012018-10-01HAL J. EARNHARDT III2020-07-08
5012017-10-01HAL J. EARNHARDT III2019-04-15
5012016-10-01
5012015-10-01HAL J EARNHARDT III
5012014-10-01HAL J EARNHARDT III
5012013-10-01HAL J EARNHARDT III
5012012-10-01HAL J. EARNHARDT III
5012011-10-01HAL J. EARNHARDT
5012010-10-01HAL J. EARNHARDT, III
5012009-10-01HAL J. EARNHARDT, III
5012008-10-01

Plan Statistics for GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY

401k plan membership statisitcs for GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY

Measure Date Value
2021: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2021 401k membership
Total participants, beginning-of-year2021-10-01750
Total number of active participants reported on line 7a of the Form 55002021-10-01566
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01566
Number of employers contributing to the scheme2021-10-010
2020: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2020 401k membership
Total participants, beginning-of-year2020-10-011,004
Total number of active participants reported on line 7a of the Form 55002020-10-01750
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01750
Number of employers contributing to the scheme2020-10-010
2019: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2019 401k membership
Total participants, beginning-of-year2019-10-01413
Total number of active participants reported on line 7a of the Form 55002019-10-011,004
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-011,004
Number of employers contributing to the scheme2019-10-010
2018: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2018 401k membership
Total participants, beginning-of-year2018-10-011,116
Total number of active participants reported on line 7a of the Form 55002018-10-01413
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01413
Number of employers contributing to the scheme2018-10-010
2017: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2017 401k membership
Total participants, beginning-of-year2017-10-011,078
Total number of active participants reported on line 7a of the Form 55002017-10-011,116
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-011,116
Number of employers contributing to the scheme2017-10-010
2016: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2016 401k membership
Total participants, beginning-of-year2016-10-01979
Total number of active participants reported on line 7a of the Form 55002016-10-011,078
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-011,078
2015: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2015 401k membership
Total participants, beginning-of-year2015-10-01929
Total number of active participants reported on line 7a of the Form 55002015-10-01979
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01979
2014: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2014 401k membership
Total participants, beginning-of-year2014-10-01896
Total number of active participants reported on line 7a of the Form 55002014-10-01929
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01929
2013: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2013 401k membership
Total participants, beginning-of-year2013-10-01868
Total number of active participants reported on line 7a of the Form 55002013-10-01896
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01896
2012: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2012 401k membership
Total participants, beginning-of-year2012-10-01817
Total number of active participants reported on line 7a of the Form 55002012-10-01377
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01377
2011: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2011 401k membership
Total participants, beginning-of-year2011-10-01648
Total number of active participants reported on line 7a of the Form 55002011-10-01812
Number of retired or separated participants receiving benefits2011-10-015
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01817
2010: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2010 401k membership
Total participants, beginning-of-year2010-10-01617
Total number of active participants reported on line 7a of the Form 55002010-10-01648
Number of retired or separated participants receiving benefits2010-10-016
Number of other retired or separated participants entitled to future benefits2010-10-0130
Total of all active and inactive participants2010-10-01684
2009: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2009 401k membership
Total participants, beginning-of-year2009-10-01555
Total number of active participants reported on line 7a of the Form 55002009-10-01607
Number of retired or separated participants receiving benefits2009-10-015
Total of all active and inactive participants2009-10-01612

Form 5500 Responses for GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY

2021: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2010: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan funding arrangement – General assets of the sponsorYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01This submission is the final filingNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes
2008: GROUP PLAN FOR THE EMPLOYEES OF EARNHARDT MANAGEMENT COMPANY 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9828781
Policy instance 2
Insurance contract or identification number9828781
Number of Individuals Covered1162
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $7,103
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,103
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932864
Policy instance 1
Insurance contract or identification number932864
Number of Individuals Covered539
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $111,015
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $1,361,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,770
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98287811001
Policy instance 2
Insurance contract or identification number98287811001
Number of Individuals Covered1235
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $8,471
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,471
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932864
Policy instance 1
Insurance contract or identification number932864
Number of Individuals Covered566
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $108,727
Total amount of fees paid to insurance companyUSD $23,149
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $818,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,110
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AJRY
Policy instance 3
Insurance contract or identification numberGUPR0AJRY
Number of Individuals Covered399
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $63,648
Total amount of fees paid to insurance companyUSD $19,220
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $661,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63,648
Amount paid for insurance broker fees19220
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98287811001
Policy instance 2
Insurance contract or identification number98287811001
Number of Individuals Covered750
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $8,841
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,841
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932864
Policy instance 1
Insurance contract or identification number932864
Number of Individuals Covered560
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $51,271
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $515,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $51,271
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AJRY
Policy instance 3
Insurance contract or identification numberGUPR0AJRY
Number of Individuals Covered405
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $61,315
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $640,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,315
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98287811001
Policy instance 2
Insurance contract or identification number98287811001
Number of Individuals Covered1393
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $10,246
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,246
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number932864
Policy instance 1
Insurance contract or identification number932864
Number of Individuals Covered544
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $48,387
Total amount of fees paid to insurance companyUSD $3,801
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $482,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,387
Amount paid for insurance broker fees3801
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AJRY
Policy instance 4
Insurance contract or identification numberGUPR0AJRY
Number of Individuals Covered413
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $53,586
Total amount of fees paid to insurance companyUSD $18,943
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $561,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,586
Amount paid for insurance broker fees18943
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNION DENTAL CARE OF ARIZONA, INC. (National Association of Insurance Commissioners NAIC id number: 47708 )
Policy contract number5299324
Policy instance 3
Insurance contract or identification number5299324
Number of Individuals Covered412
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $10,265
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,265
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98287811001
Policy instance 2
Insurance contract or identification number98287811001
Number of Individuals Covered1392
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $12,323
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $12,323
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5299324
Policy instance 1
Insurance contract or identification number5299324
Number of Individuals Covered485
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $40,873
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $374,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,873
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AJRY
Policy instance 4
Insurance contract or identification numberGUPR0AJRY
Number of Individuals Covered414
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $51,357
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $533,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION DENTAL CARE OF ARIZONA, INC. (National Association of Insurance Commissioners NAIC id number: 47708 )
Policy contract number5299324
Policy instance 3
Insurance contract or identification number5299324
Number of Individuals Covered440
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $10,855
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98287811001
Policy instance 2
Insurance contract or identification number98287811001
Number of Individuals Covered1423
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $13,154
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5299324
Policy instance 1
Insurance contract or identification number5299324
Number of Individuals Covered509
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $39,872
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $399,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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