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SEARING INDUSTRIES - 125 CAFETERIA PLAN 401k Plan overview

Plan NameSEARING INDUSTRIES - 125 CAFETERIA PLAN
Plan identification number 501

SEARING INDUSTRIES - 125 CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

SEARING INDUSTRIES has sponsored the creation of one or more 401k plans.

Company Name:SEARING INDUSTRIES
Employer identification number (EIN):953960025
NAIC Classification:621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEARING INDUSTRIES - 125 CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01
5012021-04-01
5012020-04-01
5012019-04-01
5012018-10-01
5012018-10-01
5012018-04-01
5012017-10-01MARGARET CANTU
5012017-04-01MARGARET CANTU
5012016-10-01MARGARET CANTU
5012015-10-01MARGARET CANTU
5012014-10-01MARGARET CANTU
5012013-10-01MARGARET CANTU
5012012-10-01MARGARET CANTU
5012011-10-01MARGARET CANTU
5012009-10-01MARGARET CANTU

Plan Statistics for SEARING INDUSTRIES - 125 CAFETERIA PLAN

401k plan membership statisitcs for SEARING INDUSTRIES - 125 CAFETERIA PLAN

Measure Date Value
2022: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01179
Total number of active participants reported on line 7a of the Form 55002022-04-01176
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01176
2021: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01184
Total number of active participants reported on line 7a of the Form 55002021-04-01179
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01179
2020: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01657
Total number of active participants reported on line 7a of the Form 55002020-04-01626
Total of all active and inactive participants2020-04-01626
Total participants2020-04-01626
2019: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01822
Number of retired or separated participants receiving benefits2019-04-01657
Total of all active and inactive participants2019-04-01657
Total participants2019-04-01657
Number of participants with account balances2019-04-010
2018: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-0125
Total number of active participants reported on line 7a of the Form 55002018-10-0125
Total of all active and inactive participants2018-10-0125
Total participants2018-10-0125
Total participants, beginning-of-year2018-04-01756
Total number of active participants reported on line 7a of the Form 55002018-04-01822
Total of all active and inactive participants2018-04-01822
Total participants2018-04-01822
2017: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-0118
Total number of active participants reported on line 7a of the Form 55002017-10-0118
Total of all active and inactive participants2017-10-0118
Total participants2017-10-0118
Total participants, beginning-of-year2017-04-010
Total number of active participants reported on line 7a of the Form 55002017-04-01756
Total of all active and inactive participants2017-04-01756
Total participants2017-04-01756
2016: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-0122
Total number of active participants reported on line 7a of the Form 55002016-10-0119
Total of all active and inactive participants2016-10-0119
Total participants2016-10-0119
2015: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-0118
Total number of active participants reported on line 7a of the Form 55002015-10-0118
Total of all active and inactive participants2015-10-0118
Total participants2015-10-0118
2014: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-0116
Total number of active participants reported on line 7a of the Form 55002014-10-0116
Total of all active and inactive participants2014-10-0116
Total participants2014-10-0116
2013: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-0119
Total number of active participants reported on line 7a of the Form 55002013-10-0117
Total of all active and inactive participants2013-10-0117
Total participants2013-10-0117
2012: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-0119
Total number of active participants reported on line 7a of the Form 55002012-10-0118
Total of all active and inactive participants2012-10-0118
Total participants2012-10-0118
2011: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-0118
Total number of active participants reported on line 7a of the Form 55002011-10-0118
Total of all active and inactive participants2011-10-0118
Total participants2011-10-0118
2009: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-0123
Total number of active participants reported on line 7a of the Form 55002009-10-0121
Total of all active and inactive participants2009-10-0121
Total participants2009-10-0121

Financial Data on SEARING INDUSTRIES - 125 CAFETERIA PLAN

Measure Date Value
2021 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2021 401k financial data
Value of total assets at end of year2021-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-03-31No
Was this plan covered by a fidelity bond2021-03-31No
If this is an individual account plan, was there a blackout period2021-03-31No
Were there any nonexempt tranactions with any party-in-interest2021-03-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-03-31No
Were any leases to which the plan was party in default or uncollectible2021-03-31No
Value of interest in pooled separate accounts at end of year2021-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-03-31No
Was there a failure to transmit to the plan any participant contributions2021-03-31No
Has the plan failed to provide any benefit when due under the plan2021-03-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-03-31No
Did the plan have assets held for investment2021-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-03-31No
2020 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2020 401k financial data
Value of total assets at end of year2020-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Was this plan covered by a fidelity bond2020-03-31No
If this is an individual account plan, was there a blackout period2020-03-31No
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Value of interest in pooled separate accounts at end of year2020-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-03-31No
Did the plan have assets held for investment2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31No
2019 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2019 401k financial data
Total plan liabilities at end of year2019-09-30$28,762
Total income from all sources2019-09-30$46,232
Expenses. Total of all expenses incurred2019-09-30$28,762
Benefits paid (including direct rollovers)2019-09-30$28,762
Total plan assets at end of year2019-09-30$46,232
Value of fidelity bond covering the plan2019-09-30$5,000
Total contributions received or receivable from participants2019-09-30$46,668
Net income (gross income less expenses)2019-09-30$17,470
Net plan assets at end of year (total assets less liabilities)2019-09-30$17,470
Net plan assets at beginning of year (total assets less liabilities)2019-09-30$0
Total contributions received or receivable from employer(s)2019-09-30$46,232
Value of total assets at end of year2019-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-03-31No
Was this plan covered by a fidelity bond2019-03-31No
If this is an individual account plan, was there a blackout period2019-03-31No
Were there any nonexempt tranactions with any party-in-interest2019-03-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-03-31No
Were any leases to which the plan was party in default or uncollectible2019-03-31No
Value of interest in pooled separate accounts at end of year2019-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-03-31No
Was there a failure to transmit to the plan any participant contributions2019-03-31No
Has the plan failed to provide any benefit when due under the plan2019-03-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-03-31No
Did the plan have assets held for investment2019-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-03-31No
2018 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2018 401k financial data
Total plan liabilities at end of year2018-09-30$28,508
Total income from all sources2018-09-30$38,321
Expenses. Total of all expenses incurred2018-09-30$28,508
Benefits paid (including direct rollovers)2018-09-30$28,508
Total plan assets at end of year2018-09-30$38,321
Value of fidelity bond covering the plan2018-09-30$5,000
Total contributions received or receivable from participants2018-09-30$38,321
Net income (gross income less expenses)2018-09-30$9,813
Net plan assets at end of year (total assets less liabilities)2018-09-30$9,813
Net plan assets at beginning of year (total assets less liabilities)2018-09-30$0
2017 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2017 401k financial data
Total plan liabilities at end of year2017-09-30$27,502
Total income from all sources2017-09-30$41,586
Expenses. Total of all expenses incurred2017-09-30$27,502
Benefits paid (including direct rollovers)2017-09-30$27,502
Total plan assets at end of year2017-09-30$41,586
Value of fidelity bond covering the plan2017-09-30$5,000
Total contributions received or receivable from participants2017-09-30$41,586
Net income (gross income less expenses)2017-09-30$14,084
Net plan assets at end of year (total assets less liabilities)2017-09-30$14,084
Net plan assets at beginning of year (total assets less liabilities)2017-09-30$0
2016 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2016 401k financial data
Total plan liabilities at end of year2016-09-30$24,446
Total income from all sources2016-09-30$34,046
Expenses. Total of all expenses incurred2016-09-30$24,446
Benefits paid (including direct rollovers)2016-09-30$24,446
Total plan assets at end of year2016-09-30$34,046
Value of fidelity bond covering the plan2016-09-30$5,000
Total contributions received or receivable from participants2016-09-30$34,046
Net income (gross income less expenses)2016-09-30$9,600
Net plan assets at end of year (total assets less liabilities)2016-09-30$9,600
Net plan assets at beginning of year (total assets less liabilities)2016-09-30$0
2015 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2015 401k financial data
Total income from all sources2015-09-30$32,296
Expenses. Total of all expenses incurred2015-09-30$24,365
Benefits paid (including direct rollovers)2015-09-30$24,365
Total plan assets at end of year2015-09-30$7,931
Value of fidelity bond covering the plan2015-09-30$5,000
Total contributions received or receivable from participants2015-09-30$32,296
Net income (gross income less expenses)2015-09-30$7,931
Net plan assets at end of year (total assets less liabilities)2015-09-30$7,931
Net plan assets at beginning of year (total assets less liabilities)2015-09-30$0
2014 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2014 401k financial data
Total income from all sources2014-09-30$33,951
Expenses. Total of all expenses incurred2014-09-30$22,618
Benefits paid (including direct rollovers)2014-09-30$22,618
Total plan assets at end of year2014-09-30$11,333
Value of fidelity bond covering the plan2014-09-30$5,000
Total contributions received or receivable from participants2014-09-30$33,951
Net income (gross income less expenses)2014-09-30$11,333
Net plan assets at end of year (total assets less liabilities)2014-09-30$11,333
Net plan assets at beginning of year (total assets less liabilities)2014-09-30$0
2013 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2013 401k financial data
Total income from all sources2013-09-30$54,507
Expenses. Total of all expenses incurred2013-09-30$41,868
Benefits paid (including direct rollovers)2013-09-30$41,868
Total plan assets at end of year2013-09-30$12,639
Value of fidelity bond covering the plan2013-09-30$5,000
Total contributions received or receivable from participants2013-09-30$54,507
Net income (gross income less expenses)2013-09-30$12,639
Net plan assets at end of year (total assets less liabilities)2013-09-30$12,639
Net plan assets at beginning of year (total assets less liabilities)2013-09-30$0
2012 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2012 401k financial data
Total income from all sources2012-09-30$51,196
Expenses. Total of all expenses incurred2012-09-30$41,194
Benefits paid (including direct rollovers)2012-09-30$41,194
Total plan assets at end of year2012-09-30$10,002
Value of fidelity bond covering the plan2012-09-30$5,000
Total contributions received or receivable from participants2012-09-30$51,196
Net income (gross income less expenses)2012-09-30$10,002
Net plan assets at end of year (total assets less liabilities)2012-09-30$10,002
2011 : SEARING INDUSTRIES - 125 CAFETERIA PLAN 2011 401k financial data
Total income from all sources2011-09-30$44,144
Expenses. Total of all expenses incurred2011-09-30$36,026
Benefits paid (including direct rollovers)2011-09-30$36,026
Total plan assets at end of year2011-09-30$8,118
Value of fidelity bond covering the plan2011-09-30$5,000
Total contributions received or receivable from participants2011-09-30$44,144
Net income (gross income less expenses)2011-09-30$8,118
Net plan assets at end of year (total assets less liabilities)2011-09-30$8,118

Form 5500 Responses for SEARING INDUSTRIES - 125 CAFETERIA PLAN

2022: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planNo
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan benefit arrangement - TrustYes
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planNo
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement - TrustYes
2017-04-01Type of plan entitySingle employer plan
2017-04-01First time form 5500 has been submittedYes
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement - TrustYes
2015: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan benefit arrangement - TrustYes
2014: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan benefit arrangement - TrustYes
2013: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement - TrustYes
2012: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement - TrustYes
2011: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement - TrustYes
2009: SEARING INDUSTRIES - 125 CAFETERIA PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number760159
Policy instance 2
Insurance contract or identification number760159
Number of Individuals Covered176
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $5,150
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,150
Insurance broker organization code?3
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberVARIOUS
Policy instance 6
Insurance contract or identification numberVARIOUS
Number of Individuals Covered157
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $105,812
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,351,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $105,812
Insurance broker organization code?3
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number1195
Policy instance 5
Insurance contract or identification number1195
Number of Individuals Covered38
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $1,423
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,423
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 4
Insurance contract or identification number904395
Number of Individuals Covered120
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $3,053
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 BenefitYes
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 $30,530
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
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 3
Insurance contract or identification number336594
Number of Individuals Covered17
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $1,479
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
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 $11,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,450
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937870
Policy instance 1
Insurance contract or identification number937870
Number of Individuals Covered116
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $9,292
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $126,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,292
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number760159
Policy instance 5
Insurance contract or identification number760159
Number of Individuals Covered179
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $5,193
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,193
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 3
Insurance contract or identification number904395
Number of Individuals Covered124
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $2,998
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 BenefitYes
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 $29,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,998
Insurance broker organization code?3
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number1195
Policy instance 6
Insurance contract or identification number1195
Number of Individuals Covered36
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $1,213
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $24,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,213
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 4
Insurance contract or identification number336594
Number of Individuals Covered18
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $1,608
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
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 $12,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,608
Insurance broker organization code?3
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered158
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $95,032
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,118,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,032
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937870
Policy instance 1
Insurance contract or identification number937870
Number of Individuals Covered117
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $9,283
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $131,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,283
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 3
Insurance contract or identification number904395
Number of Individuals Covered127
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $3,147
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,147
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248124
Policy instance 7
Insurance contract or identification number248124
Number of Individuals Covered172
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $983
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $983
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number887839G
Policy instance 6
Insurance contract or identification number887839G
Number of Individuals Covered177
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $2,375
Welfare Benefit Premiums Paid to CarrierUSD $28,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,375
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 5
Insurance contract or identification number336594
Number of Individuals Covered18
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,649
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,649
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered158
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $94,071
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,099,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,071
Insurance broker organization code?3
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number10306
Policy instance 2
Insurance contract or identification number10306
Number of Individuals Covered34
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $1,092
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,092
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937870
Policy instance 4
Insurance contract or identification number937870
Number of Individuals Covered112
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $8,848
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $125,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,848
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number887839G
Policy instance 9
Insurance contract or identification number887839G
Number of Individuals Covered177
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $2,532
Welfare Benefit Premiums Paid to CarrierUSD $31,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,532
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 8
Insurance contract or identification number336594
Number of Individuals Covered19
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,604
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,604
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number755403
Policy instance 7
Insurance contract or identification number755403
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248124
Policy instance 6
Insurance contract or identification number248124
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 5
Insurance contract or identification number904395
Number of Individuals Covered135
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $3,514
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,514
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number10306
Policy instance 4
Insurance contract or identification number10306
Number of Individuals Covered34
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $1,006
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,006
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5484426
Policy instance 2
Insurance contract or identification number5484426
Number of Individuals Covered117
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $9,655
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,655
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number
Policy instance 1
Number of Individuals Covered167
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $92,504
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,061,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,504
Insurance broker organization code?3
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5484426
Policy instance 3
Insurance contract or identification number5484426
Number of Individuals Covered8
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $276
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $276
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number
Policy instance 1
Number of Individuals Covered166
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $88,978
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,977,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $88,978
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5484426
Policy instance 2
Insurance contract or identification number5484426
Number of Individuals Covered126
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $9,538
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $136,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,538
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5484426
Policy instance 3
Insurance contract or identification number5484426
Number of Individuals Covered9
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $177
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $177
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number10306
Policy instance 4
Insurance contract or identification number10306
Number of Individuals Covered29
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $797
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $797
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 5
Insurance contract or identification number904395
Number of Individuals Covered126
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $2,833
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,833
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248124
Policy instance 6
Insurance contract or identification number248124
Number of Individuals Covered169
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $766
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $766
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number755403
Policy instance 7
Insurance contract or identification number755403
Number of Individuals Covered178
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $2,379
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,379
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 8
Insurance contract or identification number336594
Number of Individuals Covered19
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $1,476
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,465
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5484426
Policy instance 3
Insurance contract or identification number5484426
Number of Individuals Covered153
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $263
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $263
Insurance broker nameDENNIS K. GREENE INC.
DELTA DENTAL OF WYOMING (National Association of Insurance Commissioners NAIC id number: 15200 )
Policy contract number10306
Policy instance 4
Insurance contract or identification number10306
Number of Individuals Covered21
Insurance policy start date2017-06-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $682
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $682
Insurance broker nameDENNIS K. GREENE INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number904395
Policy instance 5
Insurance contract or identification number904395
Number of Individuals Covered112
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $2,728
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,728
Insurance broker nameDENNIS K. GREENE INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number755403
Policy instance 7
Insurance contract or identification number755403
Number of Individuals Covered166
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $2,215
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,215
Insurance broker nameDENNIS K. GREENE INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248124
Policy instance 6
Insurance contract or identification number248124
Number of Individuals Covered159
Total amount of commissions paid to insurance brokerUSD $785
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $785
Insurance broker nameDENNIS K. GREENE INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number336594
Policy instance 8
Insurance contract or identification number336594
Number of Individuals Covered18
Total amount of commissions paid to insurance brokerUSD $1,323
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,306
Insurance broker namePACIFIC ADVISORS LLC
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number
Policy instance 1
Number of Individuals Covered153
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $77,105
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,713,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,105
Insurance broker organization code?3
Insurance broker nameDENNIS K. GREENE INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5484426
Policy instance 2
Insurance contract or identification number5484426
Number of Individuals Covered118
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $9,023
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $128,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,023
Insurance broker nameDENNIS K. GREENE INC.

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