FIRSTSTAFF, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN
401k plan membership statisitcs for ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 69 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 69 |
| 2021: ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 117 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 117 |
| 2020: ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 142 |
| Total of all active and inactive participants | 2020-01-01 | 142 |
| 2019: ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 142 |
| Total of all active and inactive participants | 2019-01-01 | 142 |
| Total participants | 2019-01-01 | 142 |
| 2018: ESSENTIAL STAFFCARE LIMITED GROUP BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 166 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 166 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 166 |
| Number of participants with account balances | 2018-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 5 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-11-24 | | Insurance policy end date | 2023-11-23 | | Total amount of commissions paid to insurance broker | USD $486 | | Total amount of fees paid to insurance company | USD $306 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 4 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-11-24 | | Insurance policy end date | 2023-11-23 | | Total amount of commissions paid to insurance broker | USD $84 | | Total amount of fees paid to insurance company | USD $53 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 3 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2022-11-24 | | Insurance policy end date | 2023-11-23 | | Total amount of commissions paid to insurance broker | USD $595 | | Total amount of fees paid to insurance company | USD $375 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,586 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2022-11-24 | | Insurance policy end date | 2023-11-23 | | Total amount of commissions paid to insurance broker | USD $1,541 | | Total amount of fees paid to insurance company | USD $972 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2022-11-24 | | Insurance policy end date | 2023-11-23 | | Total amount of commissions paid to insurance broker | USD $5,929 | | Total amount of fees paid to insurance company | USD $4,525 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-11-24 | | Insurance policy end date | 2022-11-23 | | Total amount of commissions paid to insurance broker | USD $9,653 | | Total amount of fees paid to insurance company | USD $7,367 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,653 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7367 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2021-11-24 | | Insurance policy end date | 2022-11-23 | | Total amount of commissions paid to insurance broker | USD $2,508 | | Total amount of fees paid to insurance company | USD $1,581 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,508 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1581 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 3 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2021-11-24 | | Insurance policy end date | 2022-11-23 | | Total amount of commissions paid to insurance broker | USD $839 | | Total amount of fees paid to insurance company | USD $529 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $839 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 529 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 4 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2021-11-24 | | Insurance policy end date | 2022-11-23 | | Total amount of commissions paid to insurance broker | USD $163 | | Total amount of fees paid to insurance company | USD $103 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $708 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $163 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 103 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 5 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2021-11-24 | | Insurance policy end date | 2022-11-23 | | Total amount of commissions paid to insurance broker | USD $872 | | Total amount of fees paid to insurance company | USD $550 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $872 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 550 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | MSL-30344 |
| Policy instance | 6 |
| Insurance contract or identification number | MSL-30344 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 0 | | Commission paid to Insurance Broker | USD $0 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 5 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2020-11-24 | | Insurance policy end date | 2021-11-23 | | Total amount of commissions paid to insurance broker | USD $978 | | Total amount of fees paid to insurance company | USD $617 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $978 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 617 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 4 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2020-11-24 | | Insurance policy end date | 2021-11-23 | | Total amount of commissions paid to insurance broker | USD $198 | | Total amount of fees paid to insurance company | USD $125 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $198 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 125 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 3 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-11-24 | | Insurance policy end date | 2021-11-23 | | Total amount of commissions paid to insurance broker | USD $1,160 | | Total amount of fees paid to insurance company | USD $732 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,160 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 732 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2020-11-24 | | Insurance policy end date | 2021-11-23 | | Total amount of commissions paid to insurance broker | USD $3,145 | | Total amount of fees paid to insurance company | USD $1,985 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,145 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1985 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2020-11-24 | | Insurance policy end date | 2021-11-23 | | Total amount of commissions paid to insurance broker | USD $12,657 | | Total amount of fees paid to insurance company | USD $9,662 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,657 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 9662 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2019-11-24 | | Insurance policy end date | 2020-11-23 | | Total amount of commissions paid to insurance broker | USD $19,979 | | Total amount of fees paid to insurance company | USD $15,255 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $105,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,979 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 15255 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2019-11-24 | | Insurance policy end date | 2020-11-23 | | Total amount of commissions paid to insurance broker | USD $4,330 | | Total amount of fees paid to insurance company | USD $2,732 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,330 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2732 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 3 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2019-11-24 | | Insurance policy end date | 2020-11-23 | | Total amount of commissions paid to insurance broker | USD $1,715 | | Total amount of fees paid to insurance company | USD $1,081 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,715 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1081 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 4 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-11-24 | | Insurance policy end date | 2020-11-23 | | Total amount of commissions paid to insurance broker | USD $298 | | Total amount of fees paid to insurance company | USD $188 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $298 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 188 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 5 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2019-11-24 | | Insurance policy end date | 2020-11-23 | | Total amount of commissions paid to insurance broker | USD $1,429 | | Total amount of fees paid to insurance company | USD $902 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,429 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 902 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | MSL-30344 |
| Policy instance | 6 |
| Insurance contract or identification number | MSL-30344 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $85 | | Total amount of fees paid to insurance company | USD $187 | | Welfare Benefit Premiums Paid to Carrier | USD $20 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 109 | | Commission paid to Insurance Broker | USD $85 |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2018-11-24 | | Insurance policy end date | 2019-11-23 | | Total amount of commissions paid to insurance broker | USD $26,690 | | Total amount of fees paid to insurance company | USD $20,386 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $140,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,690 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 20386 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2018-11-24 | | Insurance policy end date | 2019-11-23 | | Total amount of commissions paid to insurance broker | USD $5,554 | | Total amount of fees paid to insurance company | USD $3,750 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,554 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3750 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 3 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2018-11-24 | | Insurance policy end date | 2019-11-23 | | Total amount of commissions paid to insurance broker | USD $2,216 | | Total amount of fees paid to insurance company | USD $1,499 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,216 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1499 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 4 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2018-11-24 | | Insurance policy end date | 2019-11-23 | | Total amount of commissions paid to insurance broker | USD $390 | | Total amount of fees paid to insurance company | USD $264 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $390 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 264 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 5 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2018-11-24 | | Insurance policy end date | 2019-11-23 | | Total amount of commissions paid to insurance broker | USD $1,611 | | Total amount of fees paid to insurance company | USD $1,100 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,611 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1100 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | MSL-30344 |
| Policy instance | 6 |
| Insurance contract or identification number | MSL-30344 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 2907400 |
| Policy instance | 2 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2017-11-24 | | Insurance policy end date | 2018-11-24 | | Total amount of commissions paid to insurance broker | USD $2,134 | | Total amount of fees paid to insurance company | USD $1,683 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,134 | | Amount paid for insurance broker fees | 1683 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISRATION | | Insurance broker organization code? | 1 |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 2907400 |
| Policy instance | 1 |
| Insurance contract or identification number | 2907400 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2017-11-24 | | Insurance policy end date | 2018-11-24 | | Total amount of commissions paid to insurance broker | USD $35,750 | | Total amount of fees paid to insurance company | USD $28,417 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $207,495 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,750 | | Amount paid for insurance broker fees | 28417 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION | | Insurance broker organization code? | 1 |
|
