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DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 401k Plan overview

Plan NameDAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN
Plan identification number 501

DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

DAVID LAWRENCE MENTAL HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:DAVID LAWRENCE MENTAL HEALTH CENTER, INC.
Employer identification number (EIN):592206025
NAIC Classification:621112
NAIC Description:Offices of Physicians, Mental Health Specialists

Additional information about DAVID LAWRENCE MENTAL HEALTH CENTER, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1982-04-13
Company Identification Number: 762852
Legal Registered Office Address: 5811 PELICAN BAY BOULEVARD - STE. 650

NAPLES

34108

More information about DAVID LAWRENCE MENTAL HEALTH CENTER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012019-07-01
5012017-07-01TOM ROMNIOS
5012015-07-01TOM ROMNIOS
5012014-07-01TOM ROMNIOS
5012013-07-01REBECCA TOOLE
5012012-07-01REBECCA TOOLE
5012011-07-01REBECCA TOOLE
5012010-10-01IVETTE ARROYO
5012009-10-01
5012009-10-01
5012009-10-01
5012009-10-01IVETTE ARROYO
5012008-10-01
5012007-10-01
5012006-10-01
5012005-10-01
5012004-10-01
5012003-10-01
5012002-10-01
5012001-10-01

Plan Statistics for DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN

401k plan membership statisitcs for DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN

Measure Date Value
2022: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01256
Total number of active participants reported on line 7a of the Form 55002022-07-01268
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01268
2021: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01250
Total number of active participants reported on line 7a of the Form 55002021-07-01256
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01256
2020: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01247
Total number of active participants reported on line 7a of the Form 55002020-07-01250
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01250
2019: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01243
Total number of active participants reported on line 7a of the Form 55002019-07-01247
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01247
2017: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01219
Total number of active participants reported on line 7a of the Form 55002017-07-01246
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01246
2015: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01187
Total number of active participants reported on line 7a of the Form 55002015-07-01153
Number of retired or separated participants receiving benefits2015-07-016
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01159
2014: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01182
Total number of active participants reported on line 7a of the Form 55002014-07-01185
Number of retired or separated participants receiving benefits2014-07-012
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01187
2013: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01282
Total number of active participants reported on line 7a of the Form 55002013-07-01175
Number of retired or separated participants receiving benefits2013-07-017
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01182
2012: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01148
Total number of active participants reported on line 7a of the Form 55002012-07-01276
Number of retired or separated participants receiving benefits2012-07-016
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01282
2011: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01186
Total number of active participants reported on line 7a of the Form 55002011-07-01146
Number of retired or separated participants receiving benefits2011-07-012
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01148
2010: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01174
Total number of active participants reported on line 7a of the Form 55002010-10-01180
Number of retired or separated participants receiving benefits2010-10-016
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-10-010
2009: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01175
Total number of active participants reported on line 7a of the Form 55002009-10-01168
Number of retired or separated participants receiving benefits2009-10-016
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-10-010
Total participants2009-10-01174
2008: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year2008-10-01169
Total number of active participants reported on line 7a of the Form 55002008-10-01165
Number of retired or separated participants receiving benefits2008-10-0110
Number of other retired or separated participants entitled to future benefits2008-10-010
Total of all active and inactive participants2008-10-01175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-10-010
Total participants2008-10-01175
2007: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year2007-10-01184
Total number of active participants reported on line 7a of the Form 55002007-10-01165
Number of retired or separated participants receiving benefits2007-10-014
Number of other retired or separated participants entitled to future benefits2007-10-010
Total of all active and inactive participants2007-10-01169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-10-010
Total participants2007-10-01169
2006: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year2006-10-01203
Total number of active participants reported on line 7a of the Form 55002006-10-01179
Number of retired or separated participants receiving benefits2006-10-015
Number of other retired or separated participants entitled to future benefits2006-10-010
Total of all active and inactive participants2006-10-01184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-10-010
Total participants2006-10-01184
2005: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year2005-10-01192
Total number of active participants reported on line 7a of the Form 55002005-10-01197
Number of retired or separated participants receiving benefits2005-10-016
Number of other retired or separated participants entitled to future benefits2005-10-010
Total of all active and inactive participants2005-10-01203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2005-10-010
Total participants2005-10-01203
2004: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year2004-10-01215
Total number of active participants reported on line 7a of the Form 55002004-10-01185
Number of retired or separated participants receiving benefits2004-10-017
Number of other retired or separated participants entitled to future benefits2004-10-010
Total of all active and inactive participants2004-10-01192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2004-10-010
Total participants2004-10-01192
2003: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2003 401k membership
Total participants, beginning-of-year2003-10-01210
Total number of active participants reported on line 7a of the Form 55002003-10-01212
Number of retired or separated participants receiving benefits2003-10-013
Number of other retired or separated participants entitled to future benefits2003-10-010
Total of all active and inactive participants2003-10-01215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2003-10-010
Total participants2003-10-01215
2002: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2002 401k membership
Total participants, beginning-of-year2002-10-01219
Total number of active participants reported on line 7a of the Form 55002002-10-01206
Number of retired or separated participants receiving benefits2002-10-014
Number of other retired or separated participants entitled to future benefits2002-10-010
Total of all active and inactive participants2002-10-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2002-10-010
Total participants2002-10-01210
2001: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2001 401k membership
Total participants, beginning-of-year2001-10-01217
Total number of active participants reported on line 7a of the Form 55002001-10-01216
Number of retired or separated participants receiving benefits2001-10-013
Number of other retired or separated participants entitled to future benefits2001-10-010
Total of all active and inactive participants2001-10-01219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2001-10-010
Total participants2001-10-01219

Form 5500 Responses for DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN

2022: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS 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 – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes
2008: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo
2008-10-01Plan funding arrangement – InsuranceYes
2008-10-01Plan benefit arrangement – InsuranceYes
2007: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2007 form 5500 responses
2007-10-01Type of plan entitySingle employer plan
2007-10-01Submission has been amendedNo
2007-10-01This submission is the final filingNo
2007-10-01This return/report is a short plan year return/report (less than 12 months)No
2007-10-01Plan is a collectively bargained planNo
2007-10-01Plan funding arrangement – InsuranceYes
2007-10-01Plan benefit arrangement – InsuranceYes
2006: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2006 form 5500 responses
2006-10-01Type of plan entitySingle employer plan
2006-10-01Submission has been amendedNo
2006-10-01This submission is the final filingNo
2006-10-01This return/report is a short plan year return/report (less than 12 months)No
2006-10-01Plan is a collectively bargained planNo
2006-10-01Plan funding arrangement – InsuranceYes
2006-10-01Plan benefit arrangement – InsuranceYes
2005: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2005 form 5500 responses
2005-10-01Type of plan entitySingle employer plan
2005-10-01Submission has been amendedNo
2005-10-01This submission is the final filingNo
2005-10-01This return/report is a short plan year return/report (less than 12 months)No
2005-10-01Plan is a collectively bargained planNo
2005-10-01Plan funding arrangement – InsuranceYes
2005-10-01Plan benefit arrangement – InsuranceYes
2004: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2004 form 5500 responses
2004-10-01Type of plan entitySingle employer plan
2004-10-01Submission has been amendedNo
2004-10-01This submission is the final filingNo
2004-10-01This return/report is a short plan year return/report (less than 12 months)No
2004-10-01Plan is a collectively bargained planNo
2004-10-01Plan funding arrangement – InsuranceYes
2004-10-01Plan benefit arrangement – InsuranceYes
2003: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2003 form 5500 responses
2003-10-01Type of plan entitySingle employer plan
2003-10-01Submission has been amendedNo
2003-10-01This submission is the final filingNo
2003-10-01This return/report is a short plan year return/report (less than 12 months)No
2003-10-01Plan is a collectively bargained planNo
2003-10-01Plan funding arrangement – InsuranceYes
2003-10-01Plan benefit arrangement – InsuranceYes
2002: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2002 form 5500 responses
2002-10-01Type of plan entitySingle employer plan
2002-10-01Submission has been amendedNo
2002-10-01This submission is the final filingNo
2002-10-01This return/report is a short plan year return/report (less than 12 months)No
2002-10-01Plan is a collectively bargained planNo
2002-10-01Plan funding arrangement – InsuranceYes
2002-10-01Plan benefit arrangement – InsuranceYes
2001: DAVID LAWRENCE MENTAL HEALTH CENTER, INC. WRAP WELFARE BENEFITS PLAN 2001 form 5500 responses
2001-10-01Type of plan entitySingle employer plan
2001-10-01Submission has been amendedNo
2001-10-01This submission is the final filingNo
2001-10-01This return/report is a short plan year return/report (less than 12 months)No
2001-10-01Plan is a collectively bargained planNo
2001-10-01Plan funding arrangement – InsuranceYes
2001-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number94074
Policy instance 6
Insurance contract or identification number94074
Number of Individuals Covered13
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $720
Welfare Benefit Premiums Paid to CarrierUSD $5,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $720
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 5
Insurance contract or identification number31123
Number of Individuals Covered24
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,618
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $15,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,995
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 4
Insurance contract or identification number31123
Number of Individuals Covered24
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $858
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $4,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $681
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 3
Insurance contract or identification number31123
Number of Individuals Covered40
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,284
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $9,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $876
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number51551
Policy instance 2
Insurance contract or identification number51551
Number of Individuals Covered209
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $106,181
Health 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 $106,181
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1044606
Policy instance 1
Insurance contract or identification number1044606
Number of Individuals Covered416
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $8,695
Total amount of fees paid to insurance companyUSD $5,070
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,695
Insurance broker organization code?3
Amount paid for insurance broker fees5070
Additional information about fees paid to insurance brokerBONUS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1044606
Policy instance 1
Insurance contract or identification number1044606
Number of Individuals Covered386
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $7,942
Total amount of fees paid to insurance companyUSD $3,829
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,942
Insurance broker organization code?3
Amount paid for insurance broker fees3829
Additional information about fees paid to insurance brokerBONUS
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number51551
Policy instance 2
Insurance contract or identification number51551
Number of Individuals Covered188
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $91,088
Health 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 $91,088
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 3
Insurance contract or identification number31123
Number of Individuals Covered42
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,525
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $10,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $995
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 4
Insurance contract or identification number31123
Number of Individuals Covered22
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $784
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $585
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 5
Insurance contract or identification number31123
Number of Individuals Covered26
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,659
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $15,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,974
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number94074
Policy instance 6
Insurance contract or identification number94074
Number of Individuals Covered15
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $841
Welfare Benefit Premiums Paid to CarrierUSD $6,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $841
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number94074
Policy instance 7
Insurance contract or identification number94074
Number of Individuals Covered16
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $835
Welfare Benefit Premiums Paid to CarrierUSD $7,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $835
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 6
Insurance contract or identification number31123
Number of Individuals Covered24
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,526
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $16,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,472
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 5
Insurance contract or identification number31123
Number of Individuals Covered18
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $410
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $174
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 4
Insurance contract or identification number31123
Number of Individuals Covered35
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,375
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $10,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $632
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30026133
Policy instance 3
Insurance contract or identification number30026133
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $192
Vision 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 $192
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00616323
Policy instance 2
Insurance contract or identification number00616323
Number of Individuals Covered247
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $64,724
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $340,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,724
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1044606
Policy instance 1
Insurance contract or identification number1044606
Number of Individuals Covered414
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $7,801
Total amount of fees paid to insurance companyUSD $2,519
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $124,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,801
Amount paid for insurance broker fees-43
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1044606
Policy instance 1
Insurance contract or identification number1044606
Number of Individuals Covered413
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $6,706
Total amount of fees paid to insurance companyUSD $3,546
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,706
Amount paid for insurance broker fees43
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00616323
Policy instance 2
Insurance contract or identification number00616323
Number of Individuals Covered247
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $60,983
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $343,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,983
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30026133
Policy instance 3
Insurance contract or identification number30026133
Number of Individuals Covered157
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $1,184
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,184
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 4
Insurance contract or identification number31123
Number of Individuals Covered42
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $986
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $8,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $602
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 5
Insurance contract or identification number31123
Number of Individuals Covered27
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $355
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $2,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $220
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 6
Insurance contract or identification number31123
Number of Individuals Covered32
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,556
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $14,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,657
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 6
Insurance contract or identification number31123
Number of Individuals Covered34
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $8,142
Other welfare benefits providedDISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $25,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,183
Insurance broker organization code?3
Insurance broker nameJAKE ZIMMERMAN
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 5
Insurance contract or identification number31123
Number of Individuals Covered32
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,545
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $7,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $942
Insurance broker organization code?3
Insurance broker nameJAKE ZIMMERMAN
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number31123
Policy instance 4
Insurance contract or identification number31123
Number of Individuals Covered53
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $5,046
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $18,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,943
Insurance broker organization code?3
Insurance broker nameJAHNOI EVANS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )
Policy contract number30026133
Policy instance 3
Insurance contract or identification number30026133
Number of Individuals Covered149
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $1,203
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,203
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00616323
Policy instance 2
Insurance contract or identification number00616323
Number of Individuals Covered274
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $61,799
Total amount of fees paid to insurance companyUSD $5,742
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $266,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,799
Amount paid for insurance broker fees5742
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1044606
Policy instance 1
Insurance contract or identification number1044606
Number of Individuals Covered414
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $6,075
Total amount of fees paid to insurance companyUSD $2,259
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $122,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,075
Amount paid for insurance broker fees2259
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA INC

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