TETRA DEFENSE, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TETRA DEFENSE, LLC HEALTH AND WELFARE PLAN
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
Policy contract number | 00822 00000 |
Policy instance | 1 |
Insurance contract or identification number | 00822 00000 | Number of Individuals Covered | 122 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $8,414 | 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? | No | Commission paid to Insurance Broker | USD $8,414 | Insurance broker organization code? | 3 |
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WYSSTA INSURANCE COMPANY INC. (National Association of Insurance Commissioners NAIC id number: 12352 ) |
Policy contract number | 44280 00000 |
Policy instance | 2 |
Insurance contract or identification number | 44280 00000 | Number of Individuals Covered | 120 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,785 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,497 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,785 | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | CM10000764 |
Policy instance | 3 |
Insurance contract or identification number | CM10000764 | Number of Individuals Covered | 136 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $7,075 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,075 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
Policy contract number | L05261 |
Policy instance | 4 |
Insurance contract or identification number | L05261 | Number of Individuals Covered | 194 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $30,700 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,938,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,700 | Insurance broker organization code? | 3 |
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