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BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan NameBASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN
Plan identification number 501

BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BASIC RESOURCES, INC. has sponsored the creation of one or more 401k plans.

Company Name:BASIC RESOURCES, INC.
Employer identification number (EIN):942208599
NAIC Classification:237310
NAIC Description:Highway, Street, and Bridge Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01CASEY RAZMA2020-10-14
5012019-01-01CASEY RAZMA2021-03-23
5012018-01-01
5012018-01-01CASEY RAZMA2021-03-03
5012017-01-01
5012017-01-01CASEY RAZMA2020-02-14
5012016-01-01JAMES LANGSTON
5012016-01-01CASEY RAZMA2020-02-14
5012015-01-01JOHN SHODEN
5012015-01-01CASEY RAZMA2020-02-14
5012014-01-01JOHN SHODEN
5012014-01-01CASEY RAZMA
5012013-01-01
5012012-01-01WENDELL REED
5012011-01-01JEFFREY REED
5012010-01-01JEFFREY REED
5012009-01-01JEFFREY REED
5012008-01-01JEFFREY REED
5012007-01-01JEFFREY REED
5012006-01-01JEFFREY REED
5012005-01-01JEFFREY REED
5012004-01-01JEFFREY REED
5012003-01-01JEFFREY REED
5012002-01-01JEFFREY REED
5012001-01-01JEFFREY REED
5012000-01-01JEFFREY REED
5011999-01-01JEFFREY REED
5011998-01-01JEFFREY REED
5011997-01-01JEFFREY REED
5011996-01-01JEFFREY REED
5011995-01-01JEFFREY REED
5011994-01-01JEFFREY REED
5011993-01-01JEFFREY REED
5011992-01-01JEFFREY REED
5011991-01-01JEFFREY REED
5011990-01-01JEFFREY REED
5011989-01-01JEFFREY REED
5011988-01-01JEFFREY REED

Plan Statistics for BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01466
Total number of active participants reported on line 7a of the Form 55002022-01-01457
Number of retired or separated participants receiving benefits2022-01-013
Number of other retired or separated participants entitled to future benefits2022-01-019
Total of all active and inactive participants2022-01-01469
2021: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01457
Total number of active participants reported on line 7a of the Form 55002021-01-01462
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01466
2020: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01439
Total number of active participants reported on line 7a of the Form 55002020-01-01453
Number of retired or separated participants receiving benefits2020-01-014
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01457
2019: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01401
Total number of active participants reported on line 7a of the Form 55002019-01-01425
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-0112
Total of all active and inactive participants2019-01-01439
Number of employers contributing to the scheme2019-01-010
2018: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01355
Total number of active participants reported on line 7a of the Form 55002018-01-01388
Number of retired or separated participants receiving benefits2018-01-015
Number of other retired or separated participants entitled to future benefits2018-01-018
Total of all active and inactive participants2018-01-01401
Number of employers contributing to the scheme2018-01-010
2017: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01332
Total number of active participants reported on line 7a of the Form 55002017-01-01355
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01355
Number of employers contributing to the scheme2017-01-010
2016: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01317
Total number of active participants reported on line 7a of the Form 55002016-01-01326
Number of retired or separated participants receiving benefits2016-01-016
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01332
Number of employers contributing to the scheme2016-01-010
2015: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01280
Total number of active participants reported on line 7a of the Form 55002015-01-01314
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01317
Number of employers contributing to the scheme2015-01-010
2014: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01384
Total number of active participants reported on line 7a of the Form 55002014-01-01280
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01280
2013: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01430
Total number of active participants reported on line 7a of the Form 55002013-01-01384
Total of all active and inactive participants2013-01-01384
2012: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01405
Total number of active participants reported on line 7a of the Form 55002012-01-01430
Total of all active and inactive participants2012-01-01430
2011: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01428
Total number of active participants reported on line 7a of the Form 55002011-01-01405
Total of all active and inactive participants2011-01-01405
2010: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01428
Total number of active participants reported on line 7a of the Form 55002010-01-01428
Total of all active and inactive participants2010-01-01428
2009: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01468
Total number of active participants reported on line 7a of the Form 55002009-01-01428
Total of all active and inactive participants2009-01-01428
2008: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01503
Total number of active participants reported on line 7a of the Form 55002008-01-01468
Total of all active and inactive participants2008-01-01468
2007: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2007 401k membership
Total number of active participants reported on line 7a of the Form 55002007-01-01503
Total of all active and inactive participants2007-01-01503

Financial Data on BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2022 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$390,376
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$384,414
Total income from all sources (including contributions)2022-12-31$7,403,817
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$7,114,625
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$6,601,327
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$7,403,817
Value of total assets at end of year2022-12-31$1,781,479
Value of total assets at beginning of year2022-12-31$1,486,325
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$513,298
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$26,218
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,701,919
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$3,292,777
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$211,357
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$230,186
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$39,435
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$38,500
Total non interest bearing cash at end of year2022-12-31$412,967
Total non interest bearing cash at beginning of year2022-12-31$697,708
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$289,192
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,391,103
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,101,911
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$3,308,550
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$5,701,898
Employer contributions (assets) at end of year2022-12-31$1,157,155
Employer contributions (assets) at beginning of year2022-12-31$558,431
Contract administrator fees2022-12-31$487,080
Liabilities. Value of benefit claims payable at end of year2022-12-31$350,941
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$345,914
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2022-12-31410746749
2021 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$384,414
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$343,541
Total income from all sources (including contributions)2021-12-31$6,516,060
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$6,595,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$6,091,600
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$6,516,060
Value of total assets at end of year2021-12-31$1,486,325
Value of total assets at beginning of year2021-12-31$1,525,351
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$504,359
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$29,042
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,597,691
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-12-31$3,046,996
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$230,186
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$221,676
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$38,500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$114,289
Total non interest bearing cash at end of year2021-12-31$697,708
Total non interest bearing cash at beginning of year2021-12-31$563,108
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-79,899
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,101,911
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,181,810
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$3,044,604
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$4,918,369
Employer contributions (assets) at end of year2021-12-31$558,431
Employer contributions (assets) at beginning of year2021-12-31$740,567
Contract administrator fees2021-12-31$475,317
Liabilities. Value of benefit claims payable at end of year2021-12-31$345,914
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$229,252
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2021-12-31410746749
2020 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$343,541
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$310,414
Total income from all sources (including contributions)2020-12-31$5,850,916
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$5,913,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$5,482,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$5,850,916
Value of total assets at end of year2020-12-31$1,525,351
Value of total assets at beginning of year2020-12-31$1,554,505
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$430,353
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$37,799
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,459,742
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$2,376,994
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$221,676
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$213,358
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$114,289
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$76,474
Administrative expenses (other) incurred2020-12-31$10
Total non interest bearing cash at end of year2020-12-31$563,108
Total non interest bearing cash at beginning of year2020-12-31$110,091
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-62,281
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,181,810
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,244,091
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$3,105,850
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$4,391,174
Employer contributions (assets) at end of year2020-12-31$740,567
Employer contributions (assets) at beginning of year2020-12-31$1,231,056
Contract administrator fees2020-12-31$392,544
Liabilities. Value of benefit claims payable at end of year2020-12-31$229,252
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$233,940
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2020-12-31410746749
2019 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$310,414
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$104,139
Total income from all sources (including contributions)2019-12-31$5,172,980
Total of all expenses incurred2019-12-31$5,214,230
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,915,263
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$5,172,980
Value of total assets at end of year2019-12-31$1,554,505
Value of total assets at beginning of year2019-12-31$1,389,480
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$298,967
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$298,967
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,265,559
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$1,981,879
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$213,358
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$219,466
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$76,474
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$66,567
Total non interest bearing cash at end of year2019-12-31$110,091
Total non interest bearing cash at beginning of year2019-12-31$398,990
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-41,250
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,244,091
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,285,341
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$2,715,243
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,907,421
Employer contributions (assets) at end of year2019-12-31$1,231,056
Employer contributions (assets) at beginning of year2019-12-31$771,024
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$218,141
Liabilities. Value of benefit claims payable at end of year2019-12-31$233,940
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$37,572
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2019-12-31410746749
2018 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$104,139
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$1,123
Total income from all sources (including contributions)2018-12-31$4,481,835
Total of all expenses incurred2018-12-31$4,238,592
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$4,030,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,481,835
Value of total assets at end of year2018-12-31$1,389,480
Value of total assets at beginning of year2018-12-31$1,043,221
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$207,692
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$207,692
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,149,989
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$876,655
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$219,466
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$8,550
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$66,567
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Administrative expenses (other) incurred2018-12-31$0
Total non interest bearing cash at end of year2018-12-31$398,990
Total non interest bearing cash at beginning of year2018-12-31$979,157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$243,243
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,285,341
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,042,098
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$2,844,967
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,331,846
Employer contributions (assets) at end of year2018-12-31$771,024
Employer contributions (assets) at beginning of year2018-12-31$55,514
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$309,278
Contract administrator fees2018-12-31$0
Liabilities. Value of benefit claims payable at end of year2018-12-31$37,572
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$1,123
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Liabilities. Value of acquisition indebtedness at beginning of year2018-12-31$0
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2018-12-31410746749
2017 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$1,123
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$10,654
Total income from all sources (including contributions)2017-12-31$4,217,958
Total of all expenses incurred2017-12-31$4,254,352
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$4,193,106
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$4,217,958
Value of total assets at end of year2017-12-31$1,043,221
Value of total assets at beginning of year2017-12-31$1,089,146
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$61,246
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$16,170
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$814,716
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$8,550
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$8,550
Administrative expenses (other) incurred2017-12-31$45,076
Total non interest bearing cash at end of year2017-12-31$979,157
Total non interest bearing cash at beginning of year2017-12-31$862,417
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-36,394
Value of net assets at end of year (total assets less liabilities)2017-12-31$1,042,098
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,078,492
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$3,876,761
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$3,403,242
Employer contributions (assets) at end of year2017-12-31$55,514
Employer contributions (assets) at beginning of year2017-12-31$218,179
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$316,345
Liabilities. Value of benefit claims payable at end of year2017-12-31$1,123
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$10,654
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2017-12-31410746749
2016 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$10,654
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$1,123
Total income from all sources (including contributions)2016-12-31$4,144,124
Total of all expenses incurred2016-12-31$3,902,165
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$3,826,529
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$4,144,124
Value of total assets at end of year2016-12-31$1,089,146
Value of total assets at beginning of year2016-12-31$837,656
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$75,636
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$46,860
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$420,659
Participant contributions at end of year2016-12-31$218,179
Participant contributions at beginning of year2016-12-31$1,195
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$8,550
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$8,550
Administrative expenses (other) incurred2016-12-31$28,776
Total non interest bearing cash at end of year2016-12-31$862,417
Total non interest bearing cash at beginning of year2016-12-31$827,911
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$241,959
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,078,492
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$836,533
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$3,470,115
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$3,723,465
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$356,414
Liabilities. Value of benefit claims payable at end of year2016-12-31$10,654
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$1,123
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2016-12-31410746749
2015 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$1,123
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$2,856
Total income from all sources (including contributions)2015-12-31$3,692,990
Total of all expenses incurred2015-12-31$3,307,948
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,297,597
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$3,692,990
Value of total assets at end of year2015-12-31$837,656
Value of total assets at beginning of year2015-12-31$454,347
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$10,351
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$10,351
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$396,179
Participant contributions at end of year2015-12-31$1,195
Participant contributions at beginning of year2015-12-31$2,086
Assets. Other investments not covered elsewhere at end of year2015-12-31$8,550
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$8,550
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$310
Total non interest bearing cash at end of year2015-12-31$827,911
Total non interest bearing cash at beginning of year2015-12-31$443,711
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$385,042
Value of net assets at end of year (total assets less liabilities)2015-12-31$836,533
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$451,491
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$3,042,621
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$3,296,811
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$254,666
Liabilities. Value of benefit claims payable at end of year2015-12-31$1,123
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$2,856
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31CLIFTONLARSONALLEN, LLP
Accountancy firm EIN2015-12-31410746749
2014 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$2,856
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$2,643
Total income from all sources (including contributions)2014-12-31$3,061,966
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$3,362,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,330,774
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$3,061,966
Value of total assets at end of year2014-12-31$454,347
Value of total assets at beginning of year2014-12-31$754,415
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$31,473
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$19,423
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$370,555
Participant contributions at end of year2014-12-31$2,086
Participant contributions at beginning of year2014-12-31$386,065
Assets. Other investments not covered elsewhere at end of year2014-12-31$8,550
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$8,550
Administrative expenses (other) incurred2014-12-31$12,050
Total non interest bearing cash at end of year2014-12-31$443,711
Total non interest bearing cash at beginning of year2014-12-31$359,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-300,281
Value of net assets at end of year (total assets less liabilities)2014-12-31$451,491
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$751,772
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$3,046,972
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,691,411
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$283,802
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Liabilities. Value of benefit claims payable at end of year2014-12-31$2,856
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$2,643
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31GALLINA LLP
Accountancy firm EIN2014-12-31942147510
2013 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$2,643
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$14,433
Total income from all sources (including contributions)2013-12-31$3,449,486
Total of all expenses incurred2013-12-31$3,587,395
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,558,732
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$3,449,486
Value of total assets at end of year2013-12-31$754,415
Value of total assets at beginning of year2013-12-31$904,114
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$28,663
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$14,896
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$800,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$591,532
Assets. Other investments not covered elsewhere at end of year2013-12-31$8,550
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$8,550
Administrative expenses (other) incurred2013-12-31$13,767
Liabilities. Value of operating payables at beginning of year2013-12-31$12,510
Total non interest bearing cash at end of year2013-12-31$359,800
Total non interest bearing cash at beginning of year2013-12-31$266,640
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-137,909
Value of net assets at end of year (total assets less liabilities)2013-12-31$751,772
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$889,681
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$3,315,942
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,857,954
Employer contributions (assets) at end of year2013-12-31$386,065
Employer contributions (assets) at beginning of year2013-12-31$628,924
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$242,790
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$2,643
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$1,923
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31GALLINA LLP
Accountancy firm EIN2013-12-31942147510
2012 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$14,433
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$4,730
Total income from all sources (including contributions)2012-12-31$3,165,419
Total of all expenses incurred2012-12-31$3,540,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,505,663
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$3,129,348
Value of total assets at end of year2012-12-31$904,114
Value of total assets at beginning of year2012-12-31$1,269,815
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$35,160
Total interest from all sources2012-12-31$1
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$17,982
Was this plan covered by a fidelity bond2012-12-31No
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$413,106
Assets. Other investments not covered elsewhere at end of year2012-12-31$8,550
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$10,140
Administrative expenses (other) incurred2012-12-31$17,178
Liabilities. Value of operating payables at end of year2012-12-31$12,510
Liabilities. Value of operating payables at beginning of year2012-12-31$0
Total non interest bearing cash at end of year2012-12-31$266,640
Total non interest bearing cash at beginning of year2012-12-31$647,710
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-375,404
Value of net assets at end of year (total assets less liabilities)2012-12-31$889,681
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$1,265,085
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Interest earned on other investments2012-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$235,240
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$235,240
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$1
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$3,426,209
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$36,070
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$2,716,242
Employer contributions (assets) at end of year2012-12-31$628,924
Employer contributions (assets) at beginning of year2012-12-31$376,725
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$79,454
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$1,923
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$4,730
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31GALLINA LLP
Accountancy firm EIN2012-12-31942147510
2011 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$4,730
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$2,303
Total income from all sources (including contributions)2011-12-31$3,280,980
Total of all expenses incurred2011-12-31$3,999,317
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,932,780
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$3,327,376
Value of total assets at end of year2011-12-31$1,269,815
Value of total assets at beginning of year2011-12-31$1,985,725
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$66,537
Total interest from all sources2011-12-31$10,557
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$38,399
Was this plan covered by a fidelity bond2011-12-31No
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,370,000
Assets. Other investments not covered elsewhere at end of year2011-12-31$10,140
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$99,596
Administrative expenses (other) incurred2011-12-31$28,138
Total non interest bearing cash at end of year2011-12-31$647,710
Total non interest bearing cash at beginning of year2011-12-31$1,196,766
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-718,337
Value of net assets at end of year (total assets less liabilities)2011-12-31$1,265,085
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$1,983,422
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Interest earned on other investments2011-12-31$10,557
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$235,240
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$281,636
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$281,636
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$3,836,497
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-56,953
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,957,376
Employer contributions (assets) at end of year2011-12-31$376,725
Employer contributions (assets) at beginning of year2011-12-31$407,727
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$96,283
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$4,730
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$2,303
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31GALLINA LLP
Accountancy firm EIN2011-12-31942147510
2010 : BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$2,303
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$7,863
Total income from all sources (including contributions)2010-12-31$3,085,050
Total of all expenses incurred2010-12-31$3,447,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$3,410,035
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$3,034,626
Value of total assets at end of year2010-12-31$1,985,725
Value of total assets at beginning of year2010-12-31$2,353,529
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$37,259
Total interest from all sources2010-12-31$11,571
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$5,387
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31Yes
Amount of non-exempt transactions with any party-in-interest2010-12-31$34,888
Contributions received from participants2010-12-31$1,275,688
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$99,596
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$64,708
Administrative expenses (other) incurred2010-12-31$31,872
Total non interest bearing cash at end of year2010-12-31$1,196,766
Total non interest bearing cash at beginning of year2010-12-31$1,576,575
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-362,244
Value of net assets at end of year (total assets less liabilities)2010-12-31$1,983,422
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,345,666
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Interest earned on other investments2010-12-31$11,571
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$281,636
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$240,253
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$240,253
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$3,237,266
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$38,853
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,758,938
Employer contributions (assets) at end of year2010-12-31$407,727
Employer contributions (assets) at beginning of year2010-12-31$471,993
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$172,769
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$2,303
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$7,863
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31GALLINA LLP
Accountancy firm EIN2010-12-31942147510

Form 5500 Responses for BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN

2022: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
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 funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BASIC RESOURCES, INC. EMPLOYEE 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 funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BASIC RESOURCES, INC. EMPLOYEE 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 funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BASIC RESOURCES, INC. EMPLOYEE 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 funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BASIC RESOURCES, INC. EMPLOYEE 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 – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BASIC RESOURCES, INC. EMPLOYEE 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 – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BASIC RESOURCES, INC. EMPLOYEE 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: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01This submission is the final filingNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement - TrustYes
2007: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01This submission is the final filingNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – TrustYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement - TrustYes
2006: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01This submission is the final filingNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan funding arrangement – TrustYes
2006-01-01Plan benefit arrangement – InsuranceYes
2006-01-01Plan benefit arrangement - TrustYes
2005: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01This submission is the final filingNo
2005-01-01Plan funding arrangement – InsuranceYes
2005-01-01Plan funding arrangement – TrustYes
2005-01-01Plan benefit arrangement – InsuranceYes
2005-01-01Plan benefit arrangement - TrustYes
2004: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01This submission is the final filingNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan funding arrangement – TrustYes
2004-01-01Plan benefit arrangement – InsuranceYes
2004-01-01Plan benefit arrangement - TrustYes
2003: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01This submission is the final filingNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan funding arrangement – TrustYes
2003-01-01Plan benefit arrangement – InsuranceYes
2003-01-01Plan benefit arrangement - TrustYes
2002: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2002 form 5500 responses
2002-01-01Type of plan entitySingle employer plan
2002-01-01This submission is the final filingNo
2002-01-01Plan funding arrangement – InsuranceYes
2002-01-01Plan funding arrangement – TrustYes
2002-01-01Plan benefit arrangement – InsuranceYes
2002-01-01Plan benefit arrangement - TrustYes
2001: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2001 form 5500 responses
2001-01-01Type of plan entitySingle employer plan
2001-01-01This submission is the final filingNo
2001-01-01Plan funding arrangement – InsuranceYes
2001-01-01Plan funding arrangement – TrustYes
2001-01-01Plan benefit arrangement – InsuranceYes
2001-01-01Plan benefit arrangement - TrustYes
2000: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 2000 form 5500 responses
2000-01-01Type of plan entitySingle employer plan
2000-01-01This submission is the final filingNo
2000-01-01Plan funding arrangement – InsuranceYes
2000-01-01Plan funding arrangement – TrustYes
2000-01-01Plan benefit arrangement – InsuranceYes
2000-01-01Plan benefit arrangement - TrustYes
1999: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1999 form 5500 responses
1999-01-01Type of plan entitySingle employer plan
1999-01-01This submission is the final filingNo
1999-01-01Plan funding arrangement – InsuranceYes
1999-01-01Plan funding arrangement – TrustYes
1999-01-01Plan benefit arrangement – InsuranceYes
1999-01-01Plan benefit arrangement - TrustYes
1998: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1998 form 5500 responses
1998-01-01Type of plan entitySingle employer plan
1998-01-01This submission is the final filingNo
1998-01-01Plan funding arrangement – InsuranceYes
1998-01-01Plan funding arrangement – TrustYes
1998-01-01Plan benefit arrangement – InsuranceYes
1998-01-01Plan benefit arrangement - TrustYes
1997: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1997 form 5500 responses
1997-01-01Type of plan entitySingle employer plan
1997-01-01This submission is the final filingNo
1997-01-01Plan funding arrangement – InsuranceYes
1997-01-01Plan funding arrangement – TrustYes
1997-01-01Plan benefit arrangement – InsuranceYes
1997-01-01Plan benefit arrangement - TrustYes
1996: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1996 form 5500 responses
1996-01-01Type of plan entitySingle employer plan
1996-01-01This submission is the final filingNo
1996-01-01Plan funding arrangement – InsuranceYes
1996-01-01Plan funding arrangement – TrustYes
1996-01-01Plan benefit arrangement – InsuranceYes
1996-01-01Plan benefit arrangement - TrustYes
1995: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1995 form 5500 responses
1995-01-01Type of plan entitySingle employer plan
1995-01-01This submission is the final filingNo
1995-01-01Plan funding arrangement – InsuranceYes
1995-01-01Plan funding arrangement – TrustYes
1995-01-01Plan benefit arrangement – InsuranceYes
1995-01-01Plan benefit arrangement - TrustYes
1994: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1994 form 5500 responses
1994-01-01Type of plan entitySingle employer plan
1994-01-01This submission is the final filingNo
1994-01-01Plan funding arrangement – InsuranceYes
1994-01-01Plan funding arrangement – TrustYes
1994-01-01Plan benefit arrangement – InsuranceYes
1994-01-01Plan benefit arrangement - TrustYes
1993: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1993 form 5500 responses
1993-01-01Type of plan entitySingle employer plan
1993-01-01This submission is the final filingNo
1993-01-01Plan funding arrangement – InsuranceYes
1993-01-01Plan funding arrangement – TrustYes
1993-01-01Plan benefit arrangement – InsuranceYes
1993-01-01Plan benefit arrangement - TrustYes
1992: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1992 form 5500 responses
1992-01-01Type of plan entitySingle employer plan
1992-01-01This submission is the final filingNo
1992-01-01Plan funding arrangement – InsuranceYes
1992-01-01Plan funding arrangement – TrustYes
1992-01-01Plan benefit arrangement – InsuranceYes
1992-01-01Plan benefit arrangement - TrustYes
1991: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1991 form 5500 responses
1991-01-01Type of plan entitySingle employer plan
1991-01-01This submission is the final filingNo
1991-01-01Plan funding arrangement – InsuranceYes
1991-01-01Plan funding arrangement – TrustYes
1991-01-01Plan benefit arrangement – InsuranceYes
1991-01-01Plan benefit arrangement - TrustYes
1990: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1990 form 5500 responses
1990-01-01Type of plan entitySingle employer plan
1990-01-01This submission is the final filingNo
1990-01-01Plan funding arrangement – InsuranceYes
1990-01-01Plan funding arrangement – TrustYes
1990-01-01Plan benefit arrangement – InsuranceYes
1990-01-01Plan benefit arrangement - TrustYes
1989: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1989 form 5500 responses
1989-01-01Type of plan entitySingle employer plan
1989-01-01This submission is the final filingNo
1989-01-01Plan funding arrangement – InsuranceYes
1989-01-01Plan funding arrangement – TrustYes
1989-01-01Plan benefit arrangement – InsuranceYes
1989-01-01Plan benefit arrangement - TrustYes
1988: BASIC RESOURCES, INC. EMPLOYEE BENEFITS PLAN 1988 form 5500 responses
1988-01-01Type of plan entitySingle employer plan
1988-01-01First time form 5500 has been submittedYes
1988-01-01This submission is the final filingNo
1988-01-01Plan funding arrangement – InsuranceYes
1988-01-01Plan funding arrangement – TrustYes
1988-01-01Plan benefit arrangement – InsuranceYes
1988-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number235522
Policy instance 7
Insurance contract or identification number235522
Number of Individuals Covered24
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $6,752
Total amount of fees paid to insurance companyUSD $3
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 $60,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,752
Amount paid for insurance broker fees3
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered398
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $96,705
Total amount of fees paid to insurance companyUSD $47
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 $2,083,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $96,705
Amount paid for insurance broker fees47
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00621989
Policy instance 2
Insurance contract or identification number00621989
Number of Individuals Covered294
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $114,928
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 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 $1,058,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $114,928
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906168
Policy instance 3
Insurance contract or identification number906168
Number of Individuals Covered116
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,484
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT INSURANCE AND CRITICAL ILLNESS
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 $64,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,484
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968361
Policy instance 4
Insurance contract or identification numberFLX968361
Number of Individuals Covered457
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $14,281
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $142,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,281
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969837
Policy instance 5
Insurance contract or identification numberOK969837
Number of Individuals Covered457
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $2,020
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $20,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,020
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK965659
Policy instance 6
Insurance contract or identification numberLK965659
Number of Individuals Covered457
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $2,293
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $22,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,293
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered183
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $95,184
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 $1,817,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,184
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00621989
Policy instance 2
Insurance contract or identification number00621989
Number of Individuals Covered305
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $114,830
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 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 $987,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $114,830
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906168
Policy instance 3
Insurance contract or identification number906168
Number of Individuals Covered114
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,879
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT AND CRITICAL ILLNESS
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 $59,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,879
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968361
Policy instance 4
Insurance contract or identification numberFLX968361
Number of Individuals Covered130
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $17,437
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $174,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,437
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969837
Policy instance 5
Insurance contract or identification numberOK969837
Number of Individuals Covered462
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $2,567
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $25,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,567
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK965659
Policy instance 6
Insurance contract or identification numberLK965659
Number of Individuals Covered102
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $3,086
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $30,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,086
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered411
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $97,168
Total amount of fees paid to insurance companyUSD $2
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 $1,964,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,168
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER SERVICE RELATED CONTRACT FEES
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00621989
Policy instance 2
Insurance contract or identification number00621989
Number of Individuals Covered280
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $107,528
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 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 $879,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $107,528
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906168
Policy instance 3
Insurance contract or identification number906168
Number of Individuals Covered104
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,381
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT AND CRITICAL ILLNESS
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 $56,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,381
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968361
Policy instance 4
Insurance contract or identification numberFLX968361
Number of Individuals Covered453
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $12,185
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $121,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,185
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969837
Policy instance 5
Insurance contract or identification numberOK969837
Number of Individuals Covered453
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $1,828
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH
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 $18,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,828
Insurance broker organization code?3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 965659
Policy instance 6
Insurance contract or identification numberLK 965659
Number of Individuals Covered453
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $2,167
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $21,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,167
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK965659
Policy instance 4
Insurance contract or identification numberLK965659
Number of Individuals Covered421
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $13,240
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $132,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,240
Amount paid for insurance broker fees0
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number621989
Policy instance 3
Insurance contract or identification number621989
Number of Individuals Covered247
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $94,310
Total amount of fees paid to insurance companyUSD $2,000
Welfare Benefit Premiums Paid to CarrierUSD $929,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,310
Amount paid for insurance broker fees2000
Additional information about fees paid to insurance brokerINCENTIVE COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906168
Policy instance 2
Insurance contract or identification number906168
Number of Individuals Covered88
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,877
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $45,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,877
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered356
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $81,061
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,667,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,061
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK965659
Policy instance 3
Insurance contract or identification numberLK965659
Number of Individuals Covered421
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $13,240
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $132,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $13,240
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 2
Insurance contract or identification number48449
Number of Individuals Covered254
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $50,157
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,099,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,157
Amount paid for insurance broker fees0
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number621989
Policy instance 3
Insurance contract or identification number621989
Number of Individuals Covered222
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $85,443
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $527,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,443
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number276345
Policy instance 1
Insurance contract or identification number276345
Number of Individuals Covered657
Insurance policy start date2018-01-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $28,812
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $513,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,812
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number276345
Policy instance 1
Insurance contract or identification number276345
Number of Individuals Covered626
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $157,488
Total amount of fees paid to insurance companyUSD $4,995
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,839,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered210
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $47,376
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 $945,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,376
Insurance broker organization code?3
Insurance broker nameANDREINI AND COMPANY
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number276345
Policy instance 2
Insurance contract or identification number276345
Number of Individuals Covered626
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $157,488
Total amount of fees paid to insurance companyUSD $4,995
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $2,839,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $157,488
Amount paid for insurance broker fees4995
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameANDREINI AND COMPANY
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 2
Insurance contract or identification number48449
Number of Individuals Covered210
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $47,376
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $945,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ANQP
Policy instance 3
Insurance contract or identification numberG000ANQP
Number of Individuals Covered277
Insurance policy start date2015-01-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,084
Total amount of fees paid to insurance companyUSD $542
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $10,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,084
Insurance broker organization code?3
Amount paid for insurance broker fees542
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker nameANCILARY INSURACNE SOLUTIONS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1041479
Policy instance 5
Insurance contract or identification number1041479
Number of Individuals Covered182
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,730
Total amount of fees paid to insurance companyUSD $2,594
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 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 $127,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,730
Amount paid for insurance broker fees2594
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276345
Policy instance 4
Insurance contract or identification number276345
Number of Individuals Covered203
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $96,781
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $1,915,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $96,781
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number276345
Policy instance 2
Insurance contract or identification number276345
Number of Individuals Covered114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $934
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 BenefitYes
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 $18,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $934
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered240
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $40,123
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 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 $1,116,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,123
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ANQP
Policy instance 5
Insurance contract or identification numberG000ANQP
Number of Individuals Covered277
Insurance policy start date2015-01-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $1,084
Total amount of fees paid to insurance companyUSD $542
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,084
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number276345
Policy instance 4
Insurance contract or identification number276345
Number of Individuals Covered114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $934
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $934
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1041479
Policy instance 3
Insurance contract or identification number1041479
Number of Individuals Covered182
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,730
Total amount of fees paid to insurance companyUSD $2,594
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,730
Amount paid for insurance broker fees2594
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 2
Insurance contract or identification number48449
Number of Individuals Covered240
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $40,123
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,116,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,123
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276345
Policy instance 1
Insurance contract or identification number276345
Number of Individuals Covered203
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $96,781
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,915,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $96,781
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number276345
Policy instance 1
Insurance contract or identification number276345
Number of Individuals Covered146
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $95,197
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 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 $1,742,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,197
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ANQP
Policy instance 2
Insurance contract or identification numberG000ANQP
Number of Individuals Covered280
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,455
Total amount of fees paid to insurance companyUSD $4,227
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $84,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,455
Insurance broker organization code?3
Amount paid for insurance broker fees4227
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker nameANCILLARY INSURANCE SOLUTIONS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1041479
Policy instance 3
Insurance contract or identification number1041479
Number of Individuals Covered191
Insurance policy start date2014-03-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,624
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 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 $116,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,624
Insurance broker organization code?3
Insurance broker nameROBERT STEPHEN HICKS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 4
Insurance contract or identification number48449
Number of Individuals Covered283
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $46,579
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 $1,286,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,579
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ANQP
Policy instance 6
Insurance contract or identification numberG000ANQP
Number of Individuals Covered133
Insurance policy start date2013-03-01
Insurance policy end date2014-03-01
Total amount of commissions paid to insurance brokerUSD $2,261
Total amount of fees paid to insurance companyUSD $1,131
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,261
Insurance broker organization code?3
Amount paid for insurance broker fees1131
Insurance broker nameANCILLARY INSURANCE SOLUTIONS
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number
Policy instance 4
Number of Individuals Covered377
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $94,717
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,889,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,717
Insurance broker organization code?3
Insurance broker name
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126385
Policy instance 3
Insurance contract or identification number000010126385
Number of Individuals Covered118
Insurance policy start date2013-01-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $590
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $590
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126384
Policy instance 2
Insurance contract or identification number000010126384
Number of Individuals Covered390
Insurance policy start date2013-01-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $3,053
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $20,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,053
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered283
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $46,579
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $1,286,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,579
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000ANQP
Policy instance 5
Insurance contract or identification numberG000ANQP
Number of Individuals Covered379
Insurance policy start date2013-03-01
Insurance policy end date2014-03-01
Total amount of commissions paid to insurance brokerUSD $10,691
Total amount of fees paid to insurance companyUSD $5,345
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $106,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,691
Insurance broker organization code?3
Amount paid for insurance broker fees5345
Insurance broker nameANCILLARY INSURANCE SOLUTIONS
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number
Policy instance 4
Number of Individuals Covered398
Insurance policy start date2012-03-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $93,865
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,877,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93,865
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered329
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $46,373
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $1,365,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,373
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126385
Policy instance 3
Insurance contract or identification number000010126385
Number of Individuals Covered118
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,663
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,663
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126384
Policy instance 2
Insurance contract or identification number000010126384
Number of Individuals Covered385
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $18,331
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $122,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,331
Insurance broker organization code?3
Insurance broker nameROBERT HICKS INSURANCE SERVICES, IN
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number
Policy instance 4
Number of Individuals Covered193
Insurance policy start date2011-03-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $74,942
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,665,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered212
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $71,321
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,847,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract number921081
Policy instance 5
Insurance contract or identification number921081
Number of Individuals Covered190
Insurance policy start date2011-01-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $6,746
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126385
Policy instance 3
Insurance contract or identification number000010126385
Number of Individuals Covered124
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,921
Total amount of fees paid to insurance companyUSD $469
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126384
Policy instance 2
Insurance contract or identification number000010126384
Number of Individuals Covered435
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $20,208
Total amount of fees paid to insurance companyUSD $2,009
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $134,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract number975812, 975811
Policy instance 5
Insurance contract or identification number975812, 975811
Number of Individuals Covered201
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $79,705
Total amount of fees paid to insurance companyUSD $56
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,717,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00440969
Policy instance 4
Insurance contract or identification number00440969
Number of Individuals Covered437
Insurance policy start date2010-01-01
Insurance policy end date2010-02-28
Total amount of commissions paid to insurance brokerUSD $2,196
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126385
Policy instance 3
Insurance contract or identification number000010126385
Number of Individuals Covered148
Insurance policy start date2010-03-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,172
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010126384
Policy instance 2
Insurance contract or identification number000010126384
Number of Individuals Covered420
Insurance policy start date2010-03-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $13,513
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $100,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number48449
Policy instance 1
Insurance contract or identification number48449
Number of Individuals Covered227
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $57,270
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,784,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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