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ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 401k Plan overview

Plan NameANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN
Plan identification number 501

ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

ANDRE BOUDIN BAKERIES INC has sponsored the creation of one or more 401k plans.

Company Name:ANDRE BOUDIN BAKERIES INC
Employer identification number (EIN):941428386
NAIC Classification:445291
NAIC Description:Baked Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01
5012020-10-01
5012019-10-01
5012018-10-01MATTHEW DOWLING2020-04-12
5012017-10-01MATT DOWLING2019-12-20
5012016-10-01MATT DOWLING
5012015-10-01ALVIN ACABA
5012015-04-01SHONN TOM
5012014-04-01SHONN TOM
5012013-04-01SHONN TOM
5012012-04-01SHONN TOM
5012011-04-01JONATHAN GOLOGORSKY
5012009-04-01 RON MACCARONE2010-09-08
5012009-04-01RON MACCARONE

Plan Statistics for ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN

401k plan membership statisitcs for ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN

Measure Date Value
2021: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01337
Total number of active participants reported on line 7a of the Form 55002021-10-01313
Number of retired or separated participants receiving benefits2021-10-012
Total of all active and inactive participants2021-10-01315
2020: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01270
Total number of active participants reported on line 7a of the Form 55002020-10-01312
Number of retired or separated participants receiving benefits2020-10-014
Total of all active and inactive participants2020-10-01316
2019: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01455
Total number of active participants reported on line 7a of the Form 55002019-10-01254
Number of retired or separated participants receiving benefits2019-10-014
Total of all active and inactive participants2019-10-01258
2018: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01427
Total number of active participants reported on line 7a of the Form 55002018-10-01455
Number of retired or separated participants receiving benefits2018-10-011
Number of other retired or separated participants entitled to future benefits2018-10-0145
Total of all active and inactive participants2018-10-01501
Number of employers contributing to the scheme2018-10-010
2017: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01435
Total number of active participants reported on line 7a of the Form 55002017-10-01410
Number of retired or separated participants receiving benefits2017-10-015
Number of other retired or separated participants entitled to future benefits2017-10-0194
Total of all active and inactive participants2017-10-01509
Number of employers contributing to the scheme2017-10-010
2016: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01523
Total number of active participants reported on line 7a of the Form 55002016-10-01511
Number of retired or separated participants receiving benefits2016-10-012
Number of other retired or separated participants entitled to future benefits2016-10-0160
Total of all active and inactive participants2016-10-01573
Total participants2016-10-01573
2015: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01576
Total number of active participants reported on line 7a of the Form 55002015-10-01523
Number of retired or separated participants receiving benefits2015-10-014
Number of other retired or separated participants entitled to future benefits2015-10-0113
Total of all active and inactive participants2015-10-01540
Total participants2015-10-01540
Total participants, beginning-of-year2015-04-01269
Total number of active participants reported on line 7a of the Form 55002015-04-01549
Number of retired or separated participants receiving benefits2015-04-013
Number of other retired or separated participants entitled to future benefits2015-04-01157
Total of all active and inactive participants2015-04-01709
Total participants2015-04-01709
2014: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01566
Total number of active participants reported on line 7a of the Form 55002014-04-01607
Number of retired or separated participants receiving benefits2014-04-011
Number of other retired or separated participants entitled to future benefits2014-04-0128
Total of all active and inactive participants2014-04-01636
Total participants2014-04-01636
2013: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01271
Total number of active participants reported on line 7a of the Form 55002013-04-01265
Number of retired or separated participants receiving benefits2013-04-014
Number of other retired or separated participants entitled to future benefits2013-04-0118
Total of all active and inactive participants2013-04-01287
Total participants2013-04-01287
2012: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01270
Total number of active participants reported on line 7a of the Form 55002012-04-01271
Number of retired or separated participants receiving benefits2012-04-013
Number of other retired or separated participants entitled to future benefits2012-04-0150
Total of all active and inactive participants2012-04-01324
Total participants2012-04-01324
2011: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01318
Total number of active participants reported on line 7a of the Form 55002011-04-01270
Number of retired or separated participants receiving benefits2011-04-015
Number of other retired or separated participants entitled to future benefits2011-04-013
Total of all active and inactive participants2011-04-01278
Total participants2011-04-01278
2009: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01431
Total number of active participants reported on line 7a of the Form 55002009-04-01400
Number of retired or separated participants receiving benefits2009-04-016
Number of other retired or separated participants entitled to future benefits2009-04-019
Total of all active and inactive participants2009-04-01415
Total participants2009-04-01415

Form 5500 Responses for ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN

2021: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Submission has been amendedNo
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planNo
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: ANDRE BOUDIN BAKERIES INC. HEALTHCARE PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )
Policy contract numberP0312706003
Policy instance 1
Insurance contract or identification numberP0312706003
Number of Individuals Covered523
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $38,254
Total amount of fees paid to insurance companyUSD $15,302
Are there contracts with allocated funds for individual policies?No
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 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 $765,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,254
Amount paid for insurance broker fees15302
Additional information about fees paid to insurance brokerPREFERRED BROKER COMPENSATION
Insurance broker organization code?3
Insurance broker nameCRAFORD BENEFIT CONSULTANTS
PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )
Policy contract numberP0312706002
Policy instance 1
Insurance contract or identification numberP0312706002
Number of Individuals Covered549
Insurance policy start date2015-04-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $22,375
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 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 $319,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,375
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRAFORD BENEFIT CONSULTANTS
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number174015
Policy instance 1
Insurance contract or identification number174015
Number of Individuals Covered566
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 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 $-929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )
Policy contract numberP0312706001
Policy instance 2
Insurance contract or identification numberP0312706001
Number of Individuals Covered607
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $35,840
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 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 $716,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,840
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRAFORD BENEFIT CONSULTANTS
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number174015
Policy instance 1
Insurance contract or identification number174015
Number of Individuals Covered265
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 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 $364,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number174015
Policy instance 1
Insurance contract or identification number174015
Number of Individuals Covered271
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $358,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number174015
Policy instance 1
Insurance contract or identification number174015
Number of Individuals Covered270
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $239,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number174015
Policy instance 1
Insurance contract or identification number174015
Number of Individuals Covered318
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $116,490
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $256,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $116,490
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRAFORD BENEFIT CONSULTANTS
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number48
Policy instance 2
Insurance contract or identification number48
Number of Individuals Covered31
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $3,061
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,061
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCRAFORD BENEFIT CONSULTANTS

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