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BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameBLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN
Plan identification number 501

BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

BLUE HERON BENEFITS TRUST, LLC has sponsored the creation of one or more 401k plans.

Company Name:BLUE HERON BENEFITS TRUST, LLC
Employer identification number (EIN):204986967
NAIC Classification:238100

Additional information about BLUE HERON BENEFITS TRUST, LLC

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 2006-04-21
Company Identification Number: 20061168302
Legal Registered Office Address: 2399 Riverside Parkway

Grand Junction
United States of America (USA)
81505

More information about BLUE HERON BENEFITS TRUST, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01TONYA MAYS2023-12-19
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01JEFFREY L CARPENTER
5012016-07-01JEFFREY L CARPENTER
5012015-07-01JEFFREY L CARPENTER
5012014-07-01JEFFREY L CARPENTER
5012013-07-01JEFFREY L CARPENTER
5012012-07-01JEFFREY L CARPENTER
5012011-07-01DANIEL M. ROBERTS

Plan Statistics for BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-0151
Total number of active participants reported on line 7a of the Form 55002021-07-0143
Total of all active and inactive participants2021-07-0143
2020: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-0155
Total number of active participants reported on line 7a of the Form 55002020-07-0151
Total of all active and inactive participants2020-07-0151
2019: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-0152
Total number of active participants reported on line 7a of the Form 55002019-07-0155
Total of all active and inactive participants2019-07-0155
2018: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0146
Total number of active participants reported on line 7a of the Form 55002018-07-0152
Total of all active and inactive participants2018-07-0152
2017: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0149
Total number of active participants reported on line 7a of the Form 55002017-07-0146
Total of all active and inactive participants2017-07-0146
2016: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0150
Total number of active participants reported on line 7a of the Form 55002016-07-0149
Total of all active and inactive participants2016-07-0149
2015: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0142
Total number of active participants reported on line 7a of the Form 55002015-07-0150
Total of all active and inactive participants2015-07-0150
2014: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-0143
Total number of active participants reported on line 7a of the Form 55002014-07-0142
Total of all active and inactive participants2014-07-0142
2013: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-0144
Total number of active participants reported on line 7a of the Form 55002013-07-0143
Total of all active and inactive participants2013-07-0143
2012: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-0145
Total number of active participants reported on line 7a of the Form 55002012-07-0144
Total of all active and inactive participants2012-07-0144
2011: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-0169
Total number of active participants reported on line 7a of the Form 55002011-07-0145
Total of all active and inactive participants2011-07-0145

Financial Data on BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN

Measure Date Value
2022 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-06-30$1,307,065
Expenses. Total of all expenses incurred2022-06-30$1,283,947
Benefits paid (including direct rollovers)2022-06-30$1,245,653
Total plan assets at end of year2022-06-30$231,849
Total plan assets at beginning of year2022-06-30$208,731
Total contributions received or receivable from participants2022-06-30$198,190
Expenses. Other expenses not covered elsewhere2022-06-30$15
Other income received2022-06-30$67
Net income (gross income less expenses)2022-06-30$23,118
Net plan assets at end of year (total assets less liabilities)2022-06-30$231,849
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$208,731
Total contributions received or receivable from employer(s)2022-06-30$1,108,808
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$38,279
2021 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-06-30$746,526
Expenses. Total of all expenses incurred2021-06-30$744,032
Benefits paid (including direct rollovers)2021-06-30$709,973
Total plan assets at end of year2021-06-30$208,731
Total plan assets at beginning of year2021-06-30$206,237
Total contributions received or receivable from participants2021-06-30$191,610
Expenses. Other expenses not covered elsewhere2021-06-30$73
Other income received2021-06-30$109
Net income (gross income less expenses)2021-06-30$2,494
Net plan assets at end of year (total assets less liabilities)2021-06-30$208,731
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$206,237
Total contributions received or receivable from employer(s)2021-06-30$554,807
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$33,986
2020 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at beginning of year2020-06-30$37
Total income from all sources2020-06-30$630,013
Expenses. Total of all expenses incurred2020-06-30$629,358
Benefits paid (including direct rollovers)2020-06-30$594,572
Total plan assets at end of year2020-06-30$206,237
Total plan assets at beginning of year2020-06-30$205,619
Total contributions received or receivable from participants2020-06-30$189,935
Expenses. Other expenses not covered elsewhere2020-06-30$202
Other income received2020-06-30$607
Net income (gross income less expenses)2020-06-30$655
Net plan assets at end of year (total assets less liabilities)2020-06-30$206,237
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$205,582
Total contributions received or receivable from employer(s)2020-06-30$439,471
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$34,584
2019 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-06-30$37
Total income from all sources2019-06-30$576,903
Expenses. Total of all expenses incurred2019-06-30$573,304
Benefits paid (including direct rollovers)2019-06-30$535,983
Total plan assets at end of year2019-06-30$205,619
Total plan assets at beginning of year2019-06-30$201,983
Total contributions received or receivable from participants2019-06-30$177,813
Expenses. Other expenses not covered elsewhere2019-06-30$36
Contributions received from other sources (not participants or employers)2019-06-30$5,528
Other income received2019-06-30$1,014
Net income (gross income less expenses)2019-06-30$3,599
Net plan assets at end of year (total assets less liabilities)2019-06-30$205,582
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$201,983
Total contributions received or receivable from employer(s)2019-06-30$392,548
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$37,285
2018 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total plan liabilities at beginning of year2018-06-30$29
Total income from all sources2018-06-30$729,192
Expenses. Total of all expenses incurred2018-06-30$727,129
Benefits paid (including direct rollovers)2018-06-30$689,635
Total plan assets at end of year2018-06-30$201,983
Total plan assets at beginning of year2018-06-30$199,949
Total contributions received or receivable from participants2018-06-30$155,130
Expenses. Other expenses not covered elsewhere2018-06-30$15
Contributions received from other sources (not participants or employers)2018-06-30$6,354
Other income received2018-06-30$158
Net income (gross income less expenses)2018-06-30$2,063
Net plan assets at end of year (total assets less liabilities)2018-06-30$201,983
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$199,920
Total contributions received or receivable from employer(s)2018-06-30$567,550
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$37,479
2017 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-06-30$29
Total plan liabilities at beginning of year2017-06-30$1,813
Total income from all sources2017-06-30$608,379
Expenses. Total of all expenses incurred2017-06-30$599,150
Benefits paid (including direct rollovers)2017-06-30$563,856
Total plan assets at end of year2017-06-30$199,949
Total plan assets at beginning of year2017-06-30$192,504
Total contributions received or receivable from participants2017-06-30$166,850
Expenses. Other expenses not covered elsewhere2017-06-30$63
Contributions received from other sources (not participants or employers)2017-06-30$4,832
Other income received2017-06-30$175
Net income (gross income less expenses)2017-06-30$9,229
Net plan assets at end of year (total assets less liabilities)2017-06-30$199,920
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$190,691
Total contributions received or receivable from employer(s)2017-06-30$436,522
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$35,231
2016 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-06-30$1,813
Total plan liabilities at beginning of year2016-06-30$29
Total income from all sources2016-06-30$404,990
Expenses. Total of all expenses incurred2016-06-30$398,179
Benefits paid (including direct rollovers)2016-06-30$361,628
Total plan assets at end of year2016-06-30$192,504
Total plan assets at beginning of year2016-06-30$183,909
Total contributions received or receivable from participants2016-06-30$140,270
Expenses. Other expenses not covered elsewhere2016-06-30$1,813
Contributions received from other sources (not participants or employers)2016-06-30$1,519
Other income received2016-06-30$175
Net income (gross income less expenses)2016-06-30$6,811
Net plan assets at end of year (total assets less liabilities)2016-06-30$190,691
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$183,880
Total contributions received or receivable from employer(s)2016-06-30$263,026
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$34,738
2015 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-06-30$29
Total income from all sources2015-06-30$528,465
Expenses. Total of all expenses incurred2015-06-30$515,942
Benefits paid (including direct rollovers)2015-06-30$482,126
Total plan assets at end of year2015-06-30$192,439
Total plan assets at beginning of year2015-06-30$179,887
Total contributions received or receivable from participants2015-06-30$121,373
Other income received2015-06-30$148
Net income (gross income less expenses)2015-06-30$12,523
Net plan assets at end of year (total assets less liabilities)2015-06-30$192,410
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$179,887
Total contributions received or receivable from employer(s)2015-06-30$406,944
Expenses. Administrative service providers (salaries,fees and commissions)2015-06-30$33,816
2014 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-06-30$92
Total income from all sources2014-06-30$732,219
Expenses. Total of all expenses incurred2014-06-30$717,000
Benefits paid (including direct rollovers)2014-06-30$685,137
Total plan assets at end of year2014-06-30$179,887
Total plan assets at beginning of year2014-06-30$164,760
Total contributions received or receivable from participants2014-06-30$87,835
Contributions received from other sources (not participants or employers)2014-06-30$3,458
Other income received2014-06-30$15
Net income (gross income less expenses)2014-06-30$15,219
Net plan assets at end of year (total assets less liabilities)2014-06-30$179,887
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$164,668
Total contributions received or receivable from employer(s)2014-06-30$640,911
Expenses. Administrative service providers (salaries,fees and commissions)2014-06-30$31,863
2013 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2013 401k financial data
Total plan liabilities at end of year2013-06-30$92
Total plan liabilities at beginning of year2013-06-30$92
Total income from all sources2013-06-30$406,440
Expenses. Total of all expenses incurred2013-06-30$355,377
Benefits paid (including direct rollovers)2013-06-30$322,584
Total plan assets at end of year2013-06-30$164,760
Total plan assets at beginning of year2013-06-30$113,697
Total contributions received or receivable from participants2013-06-30$91,286
Contributions received from other sources (not participants or employers)2013-06-30$8,565
Other income received2013-06-30$283
Net income (gross income less expenses)2013-06-30$51,063
Net plan assets at end of year (total assets less liabilities)2013-06-30$164,668
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$113,605
Total contributions received or receivable from employer(s)2013-06-30$306,306
Expenses. Administrative service providers (salaries,fees and commissions)2013-06-30$32,793
2012 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2012 401k financial data
Transfers to/from the plan2012-06-30$0
Total plan liabilities at end of year2012-06-30$92
Total plan liabilities at beginning of year2012-06-30$87,247
Total income from all sources2012-06-30$615,734
Expenses. Total of all expenses incurred2012-06-30$597,811
Benefits paid (including direct rollovers)2012-06-30$566,216
Total plan assets at end of year2012-06-30$113,697
Total plan assets at beginning of year2012-06-30$182,929
Total contributions received or receivable from participants2012-06-30$97,645
Contributions received from other sources (not participants or employers)2012-06-30$19,569
Other income received2012-06-30$462
Net income (gross income less expenses)2012-06-30$17,923
Net plan assets at end of year (total assets less liabilities)2012-06-30$113,605
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$95,682
Total contributions received or receivable from employer(s)2012-06-30$498,058
Expenses. Administrative service providers (salaries,fees and commissions)2012-06-30$31,595
2011 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2011 401k financial data
Total plan liabilities at end of year2011-06-30$87,247
Total plan liabilities at beginning of year2011-06-30$117,028
Total income from all sources2011-06-30$875,428
Expenses. Total of all expenses incurred2011-06-30$854,066
Benefits paid (including direct rollovers)2011-06-30$718,132
Total plan assets at end of year2011-06-30$182,929
Total plan assets at beginning of year2011-06-30$191,348
Total contributions received or receivable from participants2011-06-30$113,666
Contributions received from other sources (not participants or employers)2011-06-30$5,090
Other income received2011-06-30$614
Net income (gross income less expenses)2011-06-30$21,362
Net plan assets at end of year (total assets less liabilities)2011-06-30$95,682
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$74,320
Total contributions received or receivable from employer(s)2011-06-30$756,058
Expenses. Administrative service providers (salaries,fees and commissions)2011-06-30$135,934

Form 5500 Responses for BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN

2021: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberSLAICO-1028
Policy instance 4
Insurance contract or identification numberSLAICO-1028
Number of Individuals Covered43
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $193,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered41
Insurance policy start date2021-07-20
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $994
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $994
Insurance broker organization code?3
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number
Policy instance 2
Number of Individuals Covered43
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees932
Insurance broker organization code?1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered41
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $866
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $866
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered50
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $852
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $852
Insurance broker organization code?3
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number
Policy instance 2
Number of Individuals Covered51
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1052
Insurance broker organization code?1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered51
Insurance policy start date2020-07-20
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $901
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $901
Insurance broker organization code?3
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberSLAICO-1028
Policy instance 4
Insurance contract or identification numberSLAICO-1028
Number of Individuals Covered52
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $9,195
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $177,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,195
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered55
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $863
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $863
Amount paid for insurance broker fees0
Insurance broker organization code?3
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number
Policy instance 2
Number of Individuals Covered53
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1007
Insurance broker organization code?1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered55
Insurance policy start date2019-07-20
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $903
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $903
Amount paid for insurance broker fees0
Insurance broker organization code?3
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberSLAICO-1028
Policy instance 4
Insurance contract or identification numberSLAICO-1028
Number of Individuals Covered55
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $5,542
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $184,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,542
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered52
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $863
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $863
Insurance broker organization code?3
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number
Policy instance 2
Number of Individuals Covered52
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1043
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered52
Insurance policy start date2018-07-20
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $896
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
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 $896
Insurance broker organization code?3
GREENWICH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22322 )
Policy contract numberNWGC3143
Policy instance 4
Insurance contract or identification numberNWGC3143
Number of Individuals Covered52
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $168,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberS15038-B
Policy instance 4
Insurance contract or identification numberS15038-B
Number of Individuals Covered46
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $186,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered46
Insurance policy start date2017-07-20
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $756
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $756
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number
Policy instance 2
Number of Individuals Covered46
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees966
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered45
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $806
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $806
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE1I51050
Policy instance 4
Insurance contract or identification numberSE1I51050
Number of Individuals Covered50
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $122,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered50
Insurance policy start date2015-07-20
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $679
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $679
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 2
Number of Individuals Covered50
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,236
Total amount of fees paid to insurance companyUSD $887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,236
Amount paid for insurance broker fees887
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered50
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $732
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $732
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 1
Insurance contract or identification number000010143260
Number of Individuals Covered42
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $641
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $641
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191785
Policy instance 3
Insurance contract or identification number000010191785
Number of Individuals Covered42
Insurance policy start date2014-07-20
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $581
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $581
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 2
Number of Individuals Covered42
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $1,095
Total amount of fees paid to insurance companyUSD $790
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,095
Amount paid for insurance broker fees790
Insurance broker organization code?1
Insurance broker nameJACQUEY TABCUM
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE1I50946
Policy instance 4
Insurance contract or identification numberSE1I50946
Number of Individuals Covered42
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $118,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker name
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberIIS1881
Policy instance 1
Insurance contract or identification numberIIS1881
Number of Individuals Covered43
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $86,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?5
Insurance broker nameREGIONAL CARE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 2
Insurance contract or identification number000010143260
Number of Individuals Covered41
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $607
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $607
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 3
Number of Individuals Covered43
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,146
Total amount of fees paid to insurance companyUSD $826
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,146
Amount paid for insurance broker fees826
Insurance broker organization code?5
Insurance broker name
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberIIS1881
Policy instance 1
Insurance contract or identification numberIIS1881
Number of Individuals Covered44
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $83,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?5
Insurance broker nameREGIONAL CARE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 2
Insurance contract or identification number000010143260
Number of Individuals Covered44
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $404
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $404
Insurance broker organization code?3
Insurance broker nameJACQUEY TABCUM
MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 3
Number of Individuals Covered44
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $951
Total amount of fees paid to insurance companyUSD $684
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $951
Amount paid for insurance broker fees684
Insurance broker organization code?5
Insurance broker name
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010143260
Policy instance 2
Insurance contract or identification number000010143260
Number of Individuals Covered45
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $441
Total amount of fees paid to insurance companyUSD $29,000
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberIIS1881
Policy instance 1
Insurance contract or identification numberIIS1881
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,026
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number906220
Policy instance 2
Insurance contract or identification number906220
Number of Individuals Covered71
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $784
Total amount of fees paid to insurance companyUSD $32
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract number50109002125
Policy instance 1
Insurance contract or identification number50109002125
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $467
Total amount of fees paid to insurance companyUSD $4,674
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $70,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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