LEVI STRAUSS & CO. has sponsored the creation of one or more 401k plans.
Additional information about LEVI STRAUSS & CO.
Submission information for form 5500 for 401k plan LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES
401k plan membership statisitcs for LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES
| Measure | Date | Value |
|---|
| 2022: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 889 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,059 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 1,059 |
| 2021: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 923 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 846 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 3 |
| Total of all active and inactive participants | 2021-01-01 | 849 |
| 2020: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,097 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 917 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 6 |
| Total of all active and inactive participants | 2020-01-01 | 923 |
| 2019: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,095 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 1 |
| Total of all active and inactive participants | 2019-01-01 | 1,096 |
| 2018: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,038 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,130 |
| Total of all active and inactive participants | 2018-01-01 | 1,130 |
| 2017: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,039 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,032 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 1,033 |
| 2016: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 965 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 976 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 63 |
| Total of all active and inactive participants | 2016-01-01 | 1,039 |
| 2015: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 916 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 914 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 51 |
| Total of all active and inactive participants | 2015-01-01 | 965 |
| 2014: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 914 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 2 |
| Total of all active and inactive participants | 2014-01-01 | 916 |
| 2013: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-25 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-25 | 1,158 |
| Number of retired or separated participants receiving benefits | 2013-11-25 | 9 |
| Total of all active and inactive participants | 2013-11-25 | 1,167 |
| Measure | Date | Value |
|---|
| 2013 : LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2013 401k financial data |
|---|
| Total transfer of assets to this plan | 2013-12-31 | $639,254 |
| Total income from all sources (including contributions) | 2013-12-31 | $476,890 |
| Total of all expenses incurred | 2013-12-31 | $1,116,144 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $1,066,485 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $476,890 |
| Value of total assets at end of year | 2013-12-31 | $0 |
| Value of total assets at beginning of year | 2013-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $49,659 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Administrative expenses (other) incurred | 2013-12-31 | $8,486 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-639,254 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $75,566 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $476,890 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $990,919 |
| Contract administrator fees | 2013-12-31 | $41,173 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2013-12-31 | 910189318 |
| 2022: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: LEVI STRAUSS & CO. WELFARE PLAN FOR FACTORY AND CUSTOMER SERVICE CENTER EMPLOYEES 2013 form 5500 responses |
|---|
| 2013-11-25 | Type of plan entity | Single employer plan |
| 2013-11-25 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2013-11-25 | Plan is a collectively bargained plan | Yes |
| 2013-11-25 | Plan funding arrangement – Insurance | Yes |
| 2013-11-25 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-25 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-25 | Plan benefit arrangement – General assets of the sponsor | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G/S09068 |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G/S09068 | | Number of Individuals Covered | 1059 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $84,797 | | 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 number | 9867169 |
| Policy instance | 1 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1485 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $23,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G/S09068 |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G/S09068 | | Number of Individuals Covered | 846 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $76,263 | | 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 number | 9867169 |
| Policy instance | 1 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1319 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $22,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681637G/S09068 |
| Policy instance | 2 |
| Insurance contract or identification number | 681637G/S09068 | | Number of Individuals Covered | 917 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $96,491 | | 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: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 1 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1374 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $22,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 130392 |
| Policy instance | 3 |
| Insurance contract or identification number | LTD 130392 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,051 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0165673 |
| Policy instance | 2 |
| Insurance contract or identification number | 0165673 | | Number of Individuals Covered | 1499 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $42 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $117,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 42 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 1 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1750 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $30,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0165673 |
| Policy instance | 3 |
| Insurance contract or identification number | 0165673 | | Number of Individuals Covered | 1452 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,547 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $104,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2500 | | Additional information about fees paid to insurance broker | ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER US INC |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-860-039344 |
| Policy instance | 2 |
| Insurance contract or identification number | GF3-860-039344 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2016-12-01 | | Insurance policy end date | 2017-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,089 | | 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: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 1 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1665 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $30,067 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-860-039344 |
| Policy instance | 3 |
| Insurance contract or identification number | GF3-860-039344 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,250 | | 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: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 2 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1646 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $28,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 1309 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | | Other welfare benefits provided | AD&D | | 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: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 2 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1815 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,550 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 1103 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,821 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1191 | | Additional information about fees paid to insurance broker | GI 2014 BONUS RETENTION | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN BENEFITS & COMPENSATION |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9867169 |
| Policy instance | 2 |
| Insurance contract or identification number | 9867169 | | Number of Individuals Covered | 1902 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0319863 LOCAL |
| Policy instance | 1 |
| Insurance contract or identification number | 0319863 LOCAL | | Number of Individuals Covered | 1534 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,045 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1045 | | Additional information about fees paid to insurance broker | BONUS RETENTION | | Insurance broker organization code? | 3 | | Insurance broker name | AMERICAN BENEFITS & COMPENSATION |
|
