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BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 401k Plan overview

Plan NameBURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN
Plan identification number 501

BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

BURTON LUMBER & HARDWARE CO. has sponsored the creation of one or more 401k plans.

Company Name:BURTON LUMBER & HARDWARE CO.
Employer identification number (EIN):870152360
NAIC Classification:444130
NAIC Description:Hardware Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JAKE CONRAD2023-05-07 DANIEL S. BURTON2023-05-07
5012021-01-01JAKE CONRAD2022-07-19 DANIEL S. BURTON2022-07-19
5012020-01-01JAKE CONRAD2021-06-21 DANIEL S. BURTON2021-06-21
5012019-01-01JAKE CONRAD2020-07-07 DANIEL S. BURTON2020-07-07
5012018-01-01
5012018-01-01JAKE CONRAD2019-07-02 DANIEL S. BURTON2019-07-02
5012017-01-01
5012017-01-01
5012016-01-01JAKE CONRAD
5012015-01-01JAKE CONRAD
5012014-01-01JAKE CONRAD
5012013-01-01JAKE CONRAD DAN BURTON2014-07-08
5012012-01-01JAKE CONRAD DAN BURTON2013-07-29
5012011-01-01DAN BURTON DAN BURTON2012-07-23
5012009-01-01ROBERT A. BURTON
5012009-01-01ROBERT A. BURTON ROBERT A. BURTON2010-06-21
5012009-01-01ROBERT A. BURTON

Plan Statistics for BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN

401k plan membership statisitcs for BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN

Measure Date Value
2022: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01589
Total number of active participants reported on line 7a of the Form 55002022-01-01589
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01589
2021: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01552
Total number of active participants reported on line 7a of the Form 55002021-01-01588
Total of all active and inactive participants2021-01-01588
2020: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01529
Total number of active participants reported on line 7a of the Form 55002020-01-01552
Total of all active and inactive participants2020-01-01552
2019: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01529
Total of all active and inactive participants2019-01-010
2018: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01617
Total number of active participants reported on line 7a of the Form 55002018-01-01635
Total of all active and inactive participants2018-01-01635
2017: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01645
Total number of active participants reported on line 7a of the Form 55002017-01-01617
Total of all active and inactive participants2017-01-01617
2016: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01652
Total number of active participants reported on line 7a of the Form 55002016-01-01645
Total of all active and inactive participants2016-01-01645
2015: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01599
Total number of active participants reported on line 7a of the Form 55002015-01-01652
Total of all active and inactive participants2015-01-01652
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
2014: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01520
Total number of active participants reported on line 7a of the Form 55002014-01-01599
Total of all active and inactive participants2014-01-01599
2013: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01532
Total number of active participants reported on line 7a of the Form 55002013-01-01520
Total of all active and inactive participants2013-01-01520
2012: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01472
Total number of active participants reported on line 7a of the Form 55002012-01-01532
Total of all active and inactive participants2012-01-01532
2011: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01529
Total number of active participants reported on line 7a of the Form 55002011-01-01472
Total of all active and inactive participants2011-01-01472
2009: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01531
Total number of active participants reported on line 7a of the Form 55002009-01-01531
Total of all active and inactive participants2009-01-01531

Form 5500 Responses for BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN

2022: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: BURTON LUMBER AND HARDWARE WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered589
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $119,100
Total amount of fees paid to insurance companyUSD $104,213
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119,100
Insurance broker organization code?3
Amount paid for insurance broker fees104213
Additional information about fees paid to insurance brokerOVERRIDE FEES
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered246
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $10,428
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,428
Insurance broker organization code?3
UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered588
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $111,432
Total amount of fees paid to insurance companyUSD $97,503
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $111,432
Amount paid for insurance broker fees97503
Additional information about fees paid to insurance brokerPROVISION OF BENEFITS
Insurance broker organization code?3
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered244
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,289
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,289
Insurance broker organization code?3
UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered552
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $100,835
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 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 $2,739,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100,835
Insurance broker organization code?3
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered227
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $20,809
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 $165,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,809
Insurance broker organization code?3
UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered529
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $97,371
Total amount of fees paid to insurance companyUSD $85,199
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 $2,434,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,371
Insurance broker organization code?3
Amount paid for insurance broker fees85199
Additional information about fees paid to insurance brokerOVERRIDE FEES
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered221
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,145
Total amount of fees paid to insurance companyUSD $19,882
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 $146,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,145
Amount paid for insurance broker fees19882
Additional information about fees paid to insurance brokerCOMPENSATION FOR BROKER
Insurance broker organization code?3
UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered635
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $104,403
Total amount of fees paid to insurance companyUSD $91,353
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 $2,610,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $104,403
Insurance broker organization code?3
Amount paid for insurance broker fees91353
Additional information about fees paid to insurance brokerOVERRIDE FEES
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered222
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $9,288
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,288
Insurance broker organization code?3
UNIVERSITY OF UTAH INSURANCE PLANS (National Association of Insurance Commissioners NAIC id number: 15648 )
Policy contract number1641810119
Policy instance 2
Insurance contract or identification number1641810119
Number of Individuals Covered602
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $85,295
Total amount of fees paid to insurance companyUSD $85,295
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,748,102
Insurance broker organization code?3
Amount paid for insurance broker fees85295
Additional information about fees paid to insurance brokerOVERRIDE FEES
Insurance broker nameCERVA BROWNING, QUINN
DENTAL SELECT (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number12001397
Policy instance 1
Insurance contract or identification number12001397
Number of Individuals Covered217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $10,005
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,005
Insurance broker organization code?3
Insurance broker nameCERVA BROWNING, QUINN

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