Q.K., INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan Q.K., INC., DBA DENNY'S CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2019: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 266 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 0 |
| Number of employers contributing to the scheme | 2019-10-01 | 0 |
| 2018: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 266 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 266 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 266 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| 2017: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 266 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 266 |
| Number of employers contributing to the scheme | 2017-10-01 | 0 |
| 2016: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 0 |
| Total participants | 2016-10-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 312 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Number of employers contributing to the scheme | 2016-10-01 | 0 |
| 2015: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 398 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 214 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 214 |
| Number of employers contributing to the scheme | 2015-10-01 | 0 |
| 2014: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 0 |
| Total participants | 2014-10-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 398 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Number of employers contributing to the scheme | 2014-10-01 | 0 |
| 2013: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 404 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 398 |
| Total of all active and inactive participants | 2013-10-01 | 398 |
| Total participants | 2013-10-01 | 0 |
| 2012: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 413 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 404 |
| Total of all active and inactive participants | 2012-10-01 | 404 |
| Total participants | 2012-10-01 | 0 |
| 2011: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 421 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 413 |
| Total of all active and inactive participants | 2011-10-01 | 413 |
| Total participants | 2011-10-01 | 413 |
| 2010: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 421 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 0 |
| Total of all active and inactive participants | 2010-10-01 | 421 |
| Number of employers contributing to the scheme | 2010-10-01 | 0 |
| 2009: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 215 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 230 |
| Total of all active and inactive participants | 2009-10-01 | 230 |
| Total participants | 2009-10-01 | 230 |
| 2019: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | This submission is the final filing | Yes |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | Yes |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | Yes |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: Q.K., INC., DBA DENNY'S CAFETERIA PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10790-2167 |
| Policy instance | 2 |
| Insurance contract or identification number | 10790-2167 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 3 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM605473 |
| Policy instance | 4 |
| Insurance contract or identification number | SGM605473 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM605473 |
| Policy instance | 4 |
| Insurance contract or identification number | SGM605473 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10790-2167 |
| Policy instance | 2 |
| Insurance contract or identification number | 10790-2167 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,045 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,045 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 3 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 3 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM605473 |
| Policy instance | 4 |
| Insurance contract or identification number | SGM605473 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10790-2167 |
| Policy instance | 2 |
| Insurance contract or identification number | 10790-2167 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,720 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) |
| Policy contract number | 8417317 |
| Policy instance | 4 |
| Insurance contract or identification number | 8417317 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 3 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10790-2167 |
| Policy instance | 2 |
| Insurance contract or identification number | 10790-2167 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $73,516 | | Total amount of fees paid to insurance company | USD $2,014 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73,516 | | Amount paid for insurance broker fees | 2014 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05597515 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05597515 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10790-2167 |
| Policy instance | 3 |
| Insurance contract or identification number | 10790-2167 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,424 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,237 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,424 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 4 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $28,053 | | Total amount of fees paid to insurance company | USD $1,206 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,109 | | Amount paid for insurance broker fees | 756 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) |
| Policy contract number | 8417317 |
| Policy instance | 5 |
| Insurance contract or identification number | 8417317 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $14,152 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 14152 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | F2145 |
| Policy instance | 4 |
| Insurance contract or identification number | F2145 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 61227840 |
| Policy instance | 3 |
| Insurance contract or identification number | 61227840 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05597515 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05597515 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $4,732 | | Total amount of fees paid to insurance company | USD $292 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,732 | | Amount paid for insurance broker fees | 292 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 166303 |
| Policy instance | 1 |
| Insurance contract or identification number | 166303 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
