BLUE HERON BENEFITS TRUST, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan 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-year | 2021-07-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 43 |
| Total of all active and inactive participants | 2021-07-01 | 43 |
| 2020: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 51 |
| Total of all active and inactive participants | 2020-07-01 | 51 |
| 2019: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 52 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 55 |
| Total of all active and inactive participants | 2019-07-01 | 55 |
| 2018: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 52 |
| Total of all active and inactive participants | 2018-07-01 | 52 |
| 2017: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 49 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 46 |
| Total of all active and inactive participants | 2017-07-01 | 46 |
| 2016: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 49 |
| Total of all active and inactive participants | 2016-07-01 | 49 |
| 2015: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 42 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 50 |
| Total of all active and inactive participants | 2015-07-01 | 50 |
| 2014: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 42 |
| Total of all active and inactive participants | 2014-07-01 | 42 |
| 2013: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 43 |
| Total of all active and inactive participants | 2013-07-01 | 43 |
| 2012: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 44 |
| Total of all active and inactive participants | 2012-07-01 | 44 |
| 2011: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 45 |
| Total of all active and inactive participants | 2011-07-01 | 45 |
| Measure | Date | Value |
|---|
| 2022 : BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-06-30 | $1,307,065 |
| Expenses. Total of all expenses incurred | 2022-06-30 | $1,283,947 |
| Benefits paid (including direct rollovers) | 2022-06-30 | $1,245,653 |
| Total plan assets at end of year | 2022-06-30 | $231,849 |
| Total plan assets at beginning of year | 2022-06-30 | $208,731 |
| Total contributions received or receivable from participants | 2022-06-30 | $198,190 |
| Expenses. Other expenses not covered elsewhere | 2022-06-30 | $15 |
| Other income received | 2022-06-30 | $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 sources | 2021-06-30 | $746,526 |
| Expenses. Total of all expenses incurred | 2021-06-30 | $744,032 |
| Benefits paid (including direct rollovers) | 2021-06-30 | $709,973 |
| Total plan assets at end of year | 2021-06-30 | $208,731 |
| Total plan assets at beginning of year | 2021-06-30 | $206,237 |
| Total contributions received or receivable from participants | 2021-06-30 | $191,610 |
| Expenses. Other expenses not covered elsewhere | 2021-06-30 | $73 |
| Other income received | 2021-06-30 | $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 year | 2020-06-30 | $37 |
| Total income from all sources | 2020-06-30 | $630,013 |
| Expenses. Total of all expenses incurred | 2020-06-30 | $629,358 |
| Benefits paid (including direct rollovers) | 2020-06-30 | $594,572 |
| Total plan assets at end of year | 2020-06-30 | $206,237 |
| Total plan assets at beginning of year | 2020-06-30 | $205,619 |
| Total contributions received or receivable from participants | 2020-06-30 | $189,935 |
| Expenses. Other expenses not covered elsewhere | 2020-06-30 | $202 |
| Other income received | 2020-06-30 | $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 year | 2019-06-30 | $37 |
| Total income from all sources | 2019-06-30 | $576,903 |
| Expenses. Total of all expenses incurred | 2019-06-30 | $573,304 |
| Benefits paid (including direct rollovers) | 2019-06-30 | $535,983 |
| Total plan assets at end of year | 2019-06-30 | $205,619 |
| Total plan assets at beginning of year | 2019-06-30 | $201,983 |
| Total contributions received or receivable from participants | 2019-06-30 | $177,813 |
| Expenses. Other expenses not covered elsewhere | 2019-06-30 | $36 |
| Contributions received from other sources (not participants or employers) | 2019-06-30 | $5,528 |
| Other income received | 2019-06-30 | $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 year | 2018-06-30 | $29 |
| Total income from all sources | 2018-06-30 | $729,192 |
| Expenses. Total of all expenses incurred | 2018-06-30 | $727,129 |
| Benefits paid (including direct rollovers) | 2018-06-30 | $689,635 |
| Total plan assets at end of year | 2018-06-30 | $201,983 |
| Total plan assets at beginning of year | 2018-06-30 | $199,949 |
| Total contributions received or receivable from participants | 2018-06-30 | $155,130 |
| Expenses. Other expenses not covered elsewhere | 2018-06-30 | $15 |
| Contributions received from other sources (not participants or employers) | 2018-06-30 | $6,354 |
| Other income received | 2018-06-30 | $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 year | 2017-06-30 | $29 |
| Total plan liabilities at beginning of year | 2017-06-30 | $1,813 |
| Total income from all sources | 2017-06-30 | $608,379 |
| Expenses. Total of all expenses incurred | 2017-06-30 | $599,150 |
| Benefits paid (including direct rollovers) | 2017-06-30 | $563,856 |
| Total plan assets at end of year | 2017-06-30 | $199,949 |
| Total plan assets at beginning of year | 2017-06-30 | $192,504 |
| Total contributions received or receivable from participants | 2017-06-30 | $166,850 |
| Expenses. Other expenses not covered elsewhere | 2017-06-30 | $63 |
| Contributions received from other sources (not participants or employers) | 2017-06-30 | $4,832 |
| Other income received | 2017-06-30 | $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 year | 2016-06-30 | $1,813 |
| Total plan liabilities at beginning of year | 2016-06-30 | $29 |
| Total income from all sources | 2016-06-30 | $404,990 |
| Expenses. Total of all expenses incurred | 2016-06-30 | $398,179 |
| Benefits paid (including direct rollovers) | 2016-06-30 | $361,628 |
| Total plan assets at end of year | 2016-06-30 | $192,504 |
| Total plan assets at beginning of year | 2016-06-30 | $183,909 |
| Total contributions received or receivable from participants | 2016-06-30 | $140,270 |
| Expenses. Other expenses not covered elsewhere | 2016-06-30 | $1,813 |
| Contributions received from other sources (not participants or employers) | 2016-06-30 | $1,519 |
| Other income received | 2016-06-30 | $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 year | 2015-06-30 | $29 |
| Total income from all sources | 2015-06-30 | $528,465 |
| Expenses. Total of all expenses incurred | 2015-06-30 | $515,942 |
| Benefits paid (including direct rollovers) | 2015-06-30 | $482,126 |
| Total plan assets at end of year | 2015-06-30 | $192,439 |
| Total plan assets at beginning of year | 2015-06-30 | $179,887 |
| Total contributions received or receivable from participants | 2015-06-30 | $121,373 |
| Other income received | 2015-06-30 | $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 year | 2014-06-30 | $92 |
| Total income from all sources | 2014-06-30 | $732,219 |
| Expenses. Total of all expenses incurred | 2014-06-30 | $717,000 |
| Benefits paid (including direct rollovers) | 2014-06-30 | $685,137 |
| Total plan assets at end of year | 2014-06-30 | $179,887 |
| Total plan assets at beginning of year | 2014-06-30 | $164,760 |
| Total contributions received or receivable from participants | 2014-06-30 | $87,835 |
| Contributions received from other sources (not participants or employers) | 2014-06-30 | $3,458 |
| Other income received | 2014-06-30 | $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 year | 2013-06-30 | $92 |
| Total plan liabilities at beginning of year | 2013-06-30 | $92 |
| Total income from all sources | 2013-06-30 | $406,440 |
| Expenses. Total of all expenses incurred | 2013-06-30 | $355,377 |
| Benefits paid (including direct rollovers) | 2013-06-30 | $322,584 |
| Total plan assets at end of year | 2013-06-30 | $164,760 |
| Total plan assets at beginning of year | 2013-06-30 | $113,697 |
| Total contributions received or receivable from participants | 2013-06-30 | $91,286 |
| Contributions received from other sources (not participants or employers) | 2013-06-30 | $8,565 |
| Other income received | 2013-06-30 | $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 plan | 2012-06-30 | $0 |
| Total plan liabilities at end of year | 2012-06-30 | $92 |
| Total plan liabilities at beginning of year | 2012-06-30 | $87,247 |
| Total income from all sources | 2012-06-30 | $615,734 |
| Expenses. Total of all expenses incurred | 2012-06-30 | $597,811 |
| Benefits paid (including direct rollovers) | 2012-06-30 | $566,216 |
| Total plan assets at end of year | 2012-06-30 | $113,697 |
| Total plan assets at beginning of year | 2012-06-30 | $182,929 |
| Total contributions received or receivable from participants | 2012-06-30 | $97,645 |
| Contributions received from other sources (not participants or employers) | 2012-06-30 | $19,569 |
| Other income received | 2012-06-30 | $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 year | 2011-06-30 | $87,247 |
| Total plan liabilities at beginning of year | 2011-06-30 | $117,028 |
| Total income from all sources | 2011-06-30 | $875,428 |
| Expenses. Total of all expenses incurred | 2011-06-30 | $854,066 |
| Benefits paid (including direct rollovers) | 2011-06-30 | $718,132 |
| Total plan assets at end of year | 2011-06-30 | $182,929 |
| Total plan assets at beginning of year | 2011-06-30 | $191,348 |
| Total contributions received or receivable from participants | 2011-06-30 | $113,666 |
| Contributions received from other sources (not participants or employers) | 2011-06-30 | $5,090 |
| Other income received | 2011-06-30 | $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 |
| 2021: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – Trust | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement - Trust | Yes |
| 2020: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – Trust | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement - Trust | Yes |
| 2019: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – Trust | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement - Trust | Yes |
| 2018: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – Trust | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement - Trust | Yes |
| 2017: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – Trust | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement - Trust | Yes |
| 2016: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – Trust | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement - Trust | Yes |
| 2015: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – Trust | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement - Trust | Yes |
| 2014: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – Trust | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement - Trust | Yes |
| 2013: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – Trust | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement - Trust | Yes |
| 2012: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – Trust | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement - Trust | Yes |
| 2011: BLUE HERON BENEFITS TRUST, LLC EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – Trust | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement - Trust | Yes |
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | SLAICO-1028 |
| Policy instance | 4 |
| Insurance contract or identification number | SLAICO-1028 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $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: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-07-20 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $994 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $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 Covered | 43 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 932 | | Insurance broker organization code? | 1 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $866 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $866 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $852 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $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 Covered | 51 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 fees | 1052 | | Insurance broker organization code? | 1 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2020-07-20 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $901 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $901 | | Insurance broker organization code? | 3 |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | SLAICO-1028 |
| Policy instance | 4 |
| Insurance contract or identification number | SLAICO-1028 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $9,195 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $177,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,195 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $863 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $863 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 53 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 fees | 1007 | | Insurance broker organization code? | 1 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2019-07-20 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $903 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $903 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | SLAICO-1028 |
| Policy instance | 4 |
| Insurance contract or identification number | SLAICO-1028 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $5,542 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $184,732 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,542 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $863 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $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 Covered | 52 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 fees | 1043 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2018-07-20 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $896 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $896 | | Insurance broker organization code? | 3 |
|
| GREENWICH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22322 ) |
| Policy contract number | NWGC3143 |
| Policy instance | 4 |
| Insurance contract or identification number | NWGC3143 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $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 number | S15038-B |
| Policy instance | 4 |
| Insurance contract or identification number | S15038-B | | Number of Individuals Covered | 46 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $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: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2017-07-20 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $756 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $756 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| RXBENEFITS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 46 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 966 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $806 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $806 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | SE1I51050 |
| Policy instance | 4 |
| Insurance contract or identification number | SE1I51050 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $122,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2015-07-20 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $679 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $679 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 50 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,236 | | Total amount of fees paid to insurance company | USD $887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,236 | | Amount paid for insurance broker fees | 887 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $732 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $732 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 1 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $641 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $641 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010191785 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010191785 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2014-07-20 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $581 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $581 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 42 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $1,095 | | Total amount of fees paid to insurance company | USD $790 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,095 | | Amount paid for insurance broker fees | 790 | | Insurance broker organization code? | 1 | | Insurance broker name | JACQUEY TABCUM |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | SE1I50946 |
| Policy instance | 4 |
| Insurance contract or identification number | SE1I50946 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $118,318 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | IIS1881 |
| Policy instance | 1 |
| Insurance contract or identification number | IIS1881 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $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 name | REGIONAL CARE, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $607 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $607 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 43 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,146 | | Total amount of fees paid to insurance company | USD $826 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,146 | | Amount paid for insurance broker fees | 826 | | Insurance broker organization code? | 5 | | Insurance broker name | |
|
| INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 ) |
| Policy contract number | IIS1881 |
| Policy instance | 1 |
| Insurance contract or identification number | IIS1881 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $83,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 5 | | Insurance broker name | REGIONAL CARE, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $404 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $404 | | Insurance broker organization code? | 3 | | Insurance broker name | JACQUEY TABCUM |
|
| MAXORPLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 44 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $951 | | Total amount of fees paid to insurance company | USD $684 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $951 | | Amount paid for insurance broker fees | 684 | | Insurance broker organization code? | 5 | | Insurance broker name | |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010143260 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010143260 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $441 | | Total amount of fees paid to insurance company | USD $29,000 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | 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 number | IIS1881 |
| Policy instance | 1 |
| Insurance contract or identification number | IIS1881 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,026 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 number | 906220 |
| Policy instance | 2 |
| Insurance contract or identification number | 906220 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $784 | | Total amount of fees paid to insurance company | USD $32 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $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 number | 50109002125 |
| Policy instance | 1 |
| Insurance contract or identification number | 50109002125 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $467 | | Total amount of fees paid to insurance company | USD $4,674 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $70,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
