DRAKE SOFTWARE LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD
401k plan membership statisitcs for HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD
| Measure | Date | Value |
|---|
| 2022: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 82 |
| Total of all active and inactive participants | 2022-01-01 | 82 |
| 2021: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 608 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 86 |
| Total of all active and inactive participants | 2021-01-01 | 86 |
| 2020: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 627 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 608 |
| Total of all active and inactive participants | 2020-01-01 | 608 |
| 2019: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 587 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 627 |
| Total of all active and inactive participants | 2019-01-01 | 627 |
| 2018: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 599 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 587 |
| Total of all active and inactive participants | 2018-01-01 | 587 |
| 2017: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 596 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 599 |
| Total of all active and inactive participants | 2017-01-01 | 599 |
| 2016: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 521 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 596 |
| Total of all active and inactive participants | 2016-01-01 | 596 |
| Total participants | 2016-01-01 | 596 |
| 2015: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 414 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 521 |
| Total of all active and inactive participants | 2015-01-01 | 521 |
| Total participants | 2015-01-01 | 521 |
| 2014: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 404 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 414 |
| Total of all active and inactive participants | 2014-01-01 | 414 |
| Total participants | 2014-01-01 | 414 |
| 2013: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 396 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 404 |
| Total of all active and inactive participants | 2013-01-01 | 404 |
| 2012: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 390 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 396 |
| Total of all active and inactive participants | 2012-01-01 | 396 |
| 2011: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 360 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 390 |
| Total of all active and inactive participants | 2011-01-01 | 390 |
| 2010: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 356 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 4 |
| Total of all active and inactive participants | 2010-01-01 | 360 |
| 2009: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 320 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 339 |
| Total of all active and inactive participants | 2009-01-01 | 339 |
| Measure | Date | Value |
|---|
| 2016 : HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2016 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| 2022: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HEALTH CARE BENEFITS PLAN FOR THE EMPLOYEES OF DRA ENTERPRISES, LTD 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1153191 |
| Policy instance | 4 |
| Insurance contract or identification number | 1153191 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,034 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,249 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1153191 |
| Policy instance | 3 |
| Insurance contract or identification number | 1153191 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,165 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $434 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 141674271001 |
| Policy instance | 2 |
| Insurance contract or identification number | 141674271001 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $28,084 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,126,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,084 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00506019 |
| Policy instance | 1 |
| Insurance contract or identification number | 00506019 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,586 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,049 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98978361001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98978361001 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,754 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,754 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 141674279001 |
| Policy instance | 2 |
| Insurance contract or identification number | 141674279001 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 number | 00506019 |
| Policy instance | 1 |
| Insurance contract or identification number | 00506019 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $18,659 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,439 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98978361001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98978361001 | | Number of Individuals Covered | 898 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $6,575 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,575 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 081601 |
| Policy instance | 2 |
| Insurance contract or identification number | 081601 | | Number of Individuals Covered | 608 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 number | 00506019 |
| Policy instance | 1 |
| Insurance contract or identification number | 00506019 | | Number of Individuals Covered | 550 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $46,160 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $358,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,804 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98978361001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98978361001 | | Number of Individuals Covered | 876 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,670 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,670 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 081601 |
| Policy instance | 2 |
| Insurance contract or identification number | 081601 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 number | 00506019 |
| Policy instance | 1 |
| Insurance contract or identification number | 00506019 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $32,497 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $324,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,497 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9897836 |
| Policy instance | 3 |
| Insurance contract or identification number | 9897836 | | Number of Individuals Covered | 835 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,050 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,414 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 081601 |
| Policy instance | 2 |
| Insurance contract or identification number | 081601 | | Number of Individuals Covered | 587 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 number | 00506019 |
| Policy instance | 1 |
| Insurance contract or identification number | 00506019 | | Number of Individuals Covered | 632 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $32,983 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $329,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,983 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9897836 |
| Policy instance | 3 |
| Insurance contract or identification number | 9897836 | | Number of Individuals Covered | 927 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $6,060 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,060 | | Insurance broker organization code? | 3 | | Insurance broker name | DIGITAL INS INC |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 081601 |
| Policy instance | 2 |
| Insurance contract or identification number | 081601 | | Number of Individuals Covered | 599 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 number | 0009N559 |
| Policy instance | 1 |
| Insurance contract or identification number | 0009N559 | | Number of Individuals Covered | 619 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $41,728 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $417,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,728 | | Insurance broker organization code? | 3 | | Insurance broker name | DIGITAL INS INC |
|
