BUILDING INDUSTRY INSURANCE TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BUILDING INDUSTRY INSURANCE TRUST
| Measure | Date | Value |
|---|
| 2023 : BUILDING INDUSTRY INSURANCE TRUST 2023 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2023-02-28 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-02-28 | $567,457 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-02-28 | $583,205 |
| Total income from all sources (including contributions) | 2023-02-28 | $11,140,612 |
| Total loss/gain on sale of assets | 2023-02-28 | $0 |
| Total of all expenses incurred | 2023-02-28 | $10,703,454 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-02-28 | $10,104,481 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-02-28 | $11,140,575 |
| Value of total assets at end of year | 2023-02-28 | $1,183,612 |
| Value of total assets at beginning of year | 2023-02-28 | $762,202 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-02-28 | $598,973 |
| Total interest from all sources | 2023-02-28 | $37 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-02-28 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-02-28 | No |
| Administrative expenses professional fees incurred | 2023-02-28 | $14,331 |
| Was this plan covered by a fidelity bond | 2023-02-28 | Yes |
| Value of fidelity bond cover | 2023-02-28 | $76,220 |
| If this is an individual account plan, was there a blackout period | 2023-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-02-28 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-02-28 | $97,047 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-02-28 | $171,225 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-02-28 | $541,278 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-02-28 | $552,943 |
| Administrative expenses (other) incurred | 2023-02-28 | $16,070 |
| Liabilities. Value of operating payables at end of year | 2023-02-28 | $26,179 |
| Liabilities. Value of operating payables at beginning of year | 2023-02-28 | $30,262 |
| Total non interest bearing cash at end of year | 2023-02-28 | $1,086,565 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-02-28 | No |
| Value of net income/loss | 2023-02-28 | $437,158 |
| Value of net assets at end of year (total assets less liabilities) | 2023-02-28 | $616,155 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-02-28 | $178,997 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-02-28 | No |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-02-28 | $590,977 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-02-28 | $590,977 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-02-28 | $37 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-02-28 | $10,104,481 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-02-28 | No |
| Contributions received in cash from employer | 2023-02-28 | $11,140,575 |
| Contract administrator fees | 2023-02-28 | $568,572 |
| 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 | 2023-02-28 | No |
| Did the plan have assets held for investment | 2023-02-28 | Yes |
| 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 | 2023-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-02-28 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-02-28 | Unqualified |
| Accountancy firm name | 2023-02-28 | SWEENEY CONRAD, P.S. |
| Accountancy firm EIN | 2023-02-28 | 911301672 |
| 2022 : BUILDING INDUSTRY INSURANCE TRUST 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-02-28 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-02-28 | $583,205 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-02-28 | $177,765 |
| Total income from all sources (including contributions) | 2022-02-28 | $6,544,270 |
| Total loss/gain on sale of assets | 2022-02-28 | $0 |
| Total of all expenses incurred | 2022-02-28 | $6,394,598 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-02-28 | $6,046,467 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-02-28 | $6,544,230 |
| Value of total assets at end of year | 2022-02-28 | $762,202 |
| Value of total assets at beginning of year | 2022-02-28 | $207,090 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-02-28 | $348,131 |
| Total interest from all sources | 2022-02-28 | $40 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-02-28 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-02-28 | No |
| Administrative expenses professional fees incurred | 2022-02-28 | $15,748 |
| Was this plan covered by a fidelity bond | 2022-02-28 | Yes |
| Value of fidelity bond cover | 2022-02-28 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-02-28 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-02-28 | $171,225 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-02-28 | $1,240 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-02-28 | $552,943 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-02-28 | $161,428 |
| Administrative expenses (other) incurred | 2022-02-28 | $10,172 |
| Liabilities. Value of operating payables at end of year | 2022-02-28 | $30,262 |
| Liabilities. Value of operating payables at beginning of year | 2022-02-28 | $16,337 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-02-28 | No |
| Value of net income/loss | 2022-02-28 | $149,672 |
| Value of net assets at end of year (total assets less liabilities) | 2022-02-28 | $178,997 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-02-28 | $29,325 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-02-28 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-02-28 | $590,977 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-02-28 | $205,850 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-02-28 | $205,850 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-02-28 | $40 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-02-28 | $6,046,467 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-02-28 | No |
| Contributions received in cash from employer | 2022-02-28 | $6,544,230 |
| Contract administrator fees | 2022-02-28 | $322,211 |
| 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 | 2022-02-28 | No |
| Did the plan have assets held for investment | 2022-02-28 | Yes |
| 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 | 2022-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-02-28 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-02-28 | Unqualified |
| Accountancy firm name | 2022-02-28 | SWEENEY CONRAD, P.S. |
| Accountancy firm EIN | 2022-02-28 | 911301672 |
| 2021 : BUILDING INDUSTRY INSURANCE TRUST 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-02-28 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-02-28 | $177,765 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-02-28 | $115,913 |
| Total income from all sources (including contributions) | 2021-02-28 | $2,976,062 |
| Total loss/gain on sale of assets | 2021-02-28 | $0 |
| Total of all expenses incurred | 2021-02-28 | $2,953,737 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-02-28 | $2,783,202 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-02-28 | $2,975,989 |
| Value of total assets at end of year | 2021-02-28 | $207,090 |
| Value of total assets at beginning of year | 2021-02-28 | $122,913 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-02-28 | $170,535 |
| Total interest from all sources | 2021-02-28 | $73 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-02-28 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-02-28 | No |
| Administrative expenses professional fees incurred | 2021-02-28 | $15,193 |
| Was this plan covered by a fidelity bond | 2021-02-28 | Yes |
| Value of fidelity bond cover | 2021-02-28 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-02-28 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-02-28 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-02-28 | $1,240 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-02-28 | $15,727 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-02-28 | $161,428 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-02-28 | $113,084 |
| Administrative expenses (other) incurred | 2021-02-28 | $1,109 |
| Liabilities. Value of operating payables at end of year | 2021-02-28 | $16,337 |
| Liabilities. Value of operating payables at beginning of year | 2021-02-28 | $2,829 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-02-28 | No |
| Value of net income/loss | 2021-02-28 | $22,325 |
| Value of net assets at end of year (total assets less liabilities) | 2021-02-28 | $29,325 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-02-28 | $7,000 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-02-28 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-02-28 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-02-28 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-02-28 | $205,850 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-02-28 | $107,186 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-02-28 | $107,186 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-02-28 | $73 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-02-28 | $2,783,202 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-02-28 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-02-28 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-02-28 | No |
| Contributions received in cash from employer | 2021-02-28 | $2,975,989 |
| Contract administrator fees | 2021-02-28 | $154,233 |
| 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 | 2021-02-28 | No |
| Did the plan have assets held for investment | 2021-02-28 | Yes |
| 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 | 2021-02-28 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-02-28 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-02-28 | Unqualified |
| Accountancy firm name | 2021-02-28 | SWEENEY CONRAD, P.S. |
| Accountancy firm EIN | 2021-02-28 | 911301672 |
| 2020 : BUILDING INDUSTRY INSURANCE TRUST 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-02-29 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-02-29 | $115,913 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-02-29 | $0 |
| Total income from all sources (including contributions) | 2020-02-29 | $876,790 |
| Total loss/gain on sale of assets | 2020-02-29 | $0 |
| Total of all expenses incurred | 2020-02-29 | $869,790 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-02-29 | $826,351 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-02-29 | $876,672 |
| Value of total assets at end of year | 2020-02-29 | $122,913 |
| Value of total assets at beginning of year | 2020-02-29 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-02-29 | $43,439 |
| Total interest from all sources | 2020-02-29 | $118 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-02-29 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-02-29 | No |
| Administrative expenses professional fees incurred | 2020-02-29 | $1,268 |
| Was this plan covered by a fidelity bond | 2020-02-29 | Yes |
| Value of fidelity bond cover | 2020-02-29 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-02-29 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-02-29 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-02-29 | $15,727 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-02-29 | $113,084 |
| Administrative expenses (other) incurred | 2020-02-29 | $371 |
| Liabilities. Value of operating payables at end of year | 2020-02-29 | $2,829 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-02-29 | No |
| Value of net income/loss | 2020-02-29 | $7,000 |
| Value of net assets at end of year (total assets less liabilities) | 2020-02-29 | $7,000 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-02-29 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-02-29 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-02-29 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-02-29 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-02-29 | $107,186 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-02-29 | $118 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-02-29 | $826,351 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-02-29 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-02-29 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-02-29 | No |
| Contributions received in cash from employer | 2020-02-29 | $876,672 |
| Contract administrator fees | 2020-02-29 | $41,800 |
| Did the plan have assets held for investment | 2020-02-29 | Yes |
| 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 | 2020-02-29 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-02-29 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-02-29 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-02-29 | Unqualified |
| Accountancy firm name | 2020-02-29 | SWEENEY CONRAD, P.S. |
| Accountancy firm EIN | 2020-02-29 | 911301672 |
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001T00001 |
| Policy instance | 2 |
| Insurance contract or identification number | BIIT00001T00001 | | Number of Individuals Covered | 1502 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $36,104 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $626,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,104 | | Insurance broker organization code? | 3 |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 800000037 |
| Policy instance | 1 |
| Insurance contract or identification number | 800000037 | | Number of Individuals Covered | 2718 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $364,941 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $9,489,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $364,941 | | Insurance broker organization code? | 3 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001T00001 |
| Policy instance | 4 |
| Insurance contract or identification number | BIIT00001T00001 | | Number of Individuals Covered | 1340 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $6,016 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $60,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,016 | | Insurance broker organization code? | 3 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001T00001 |
| Policy instance | 3 |
| Insurance contract or identification number | BIIT00001T00001 | | Number of Individuals Covered | 619 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $3,172 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $63,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,172 | | Insurance broker organization code? | 3 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001T00001 |
| Policy instance | 2 |
| Insurance contract or identification number | BIIT00001T00001 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $13,307 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $266,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,307 | | Insurance broker organization code? | 3 |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 800000037 |
| Policy instance | 1 |
| Insurance contract or identification number | 800000037 | | Number of Individuals Covered | 2105 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $224,638 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $5,265,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $224,638 | | Insurance broker organization code? | 3 |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001T00001 |
| Policy instance | 2 |
| Insurance contract or identification number | BIIT00001T00001 | | Number of Individuals Covered | 498 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $12,610 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $224,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,610 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 800000037 |
| Policy instance | 1 |
| Insurance contract or identification number | 800000037 | | Number of Individuals Covered | 700 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $87,846 | | Total amount of fees paid to insurance company | USD $760 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $2,509,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,846 | | Amount paid for insurance broker fees | 760 | | Additional information about fees paid to insurance broker | SUB-PRODUCER PAYMENTS | | Insurance broker organization code? | 3 |
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| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 800000037 |
| Policy instance | 4 |
| Insurance contract or identification number | 800000037 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $22,761 | | Total amount of fees paid to insurance company | USD $7,480 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $650,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,761 | | Amount paid for insurance broker fees | 7480 | | Additional information about fees paid to insurance broker | SUB-PRODUCER PAYMENTS | | Insurance broker organization code? | 3 |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001-T0000 |
| Policy instance | 3 |
| Insurance contract or identification number | BIIT00001-T0000 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $696 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ADD | | 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 Carrier | USD $6,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $696 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001-T0000 |
| Policy instance | 2 |
| Insurance contract or identification number | BIIT00001-T0000 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $377 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $7,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $377 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | BIIT00001-T0000 |
| Policy instance | 1 |
| Insurance contract or identification number | BIIT00001-T0000 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $2,423 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $48,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,423 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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