SAINT JEAN INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE
401k plan membership statisitcs for SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE
| Measure | Date | Value |
|---|
| 2021: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 329 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 299 |
| Total of all active and inactive participants | 2021-10-01 | 299 |
| 2020: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 374 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 329 |
| Total of all active and inactive participants | 2020-10-01 | 329 |
| 2019: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 382 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 374 |
| Total of all active and inactive participants | 2019-10-01 | 374 |
| 2018: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 367 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 382 |
| Total of all active and inactive participants | 2018-10-01 | 382 |
| 2017: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 301 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 367 |
| Total of all active and inactive participants | 2017-10-01 | 367 |
| 2016: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 271 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 301 |
| Total of all active and inactive participants | 2016-10-01 | 301 |
| 2015: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 271 |
| Total of all active and inactive participants | 2015-10-01 | 271 |
| 2014: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 62 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 174 |
| Total of all active and inactive participants | 2014-10-01 | 174 |
| 2013: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 62 |
| Total of all active and inactive participants | 2013-10-01 | 62 |
| 2012: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 421 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 200 |
| Total of all active and inactive participants | 2012-10-01 | 200 |
| 2011: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 421 |
| Total of all active and inactive participants | 2011-10-01 | 421 |
| 2009: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 259 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 337 |
| Total of all active and inactive participants | 2009-10-01 | 337 |
| Total participants | 2009-10-01 | 337 |
| 2008: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-10-01 | 219 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 259 |
| Total of all active and inactive participants | 2008-10-01 | 259 |
| Total participants | 2008-10-01 | 259 |
| 2021: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: SAINT JEAN INDUSTRIES, INC. WELFARE BENEFIT/CAFETE 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| 2008-10-01 | Plan funding arrangement – Insurance | Yes |
| 2008-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061322 |
| Policy instance | 10 |
| Insurance contract or identification number | 061322 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017798 |
| Policy instance | 1 |
| Insurance contract or identification number | 017798 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028312 |
| Policy instance | 2 |
| Insurance contract or identification number | 028312 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 3 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $825 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $24,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $624 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 4 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,840 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $20,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,394 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 5 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $240 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $14,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $200 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 6 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $402 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $335 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 7 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,547 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,123 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 8 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-20 | | Total amount of commissions paid to insurance broker | USD $2,555 | | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | | Welfare Benefit Premiums Paid to Carrier | USD $42,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,129 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 9 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,741 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,451 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028312 |
| Policy instance | 2 |
| Insurance contract or identification number | 028312 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017798 |
| Policy instance | 1 |
| Insurance contract or identification number | 017798 | | Number of Individuals Covered | 333 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 3 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $834 | | Total amount of fees paid to insurance company | USD $10 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $12,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $453 | | Amount paid for insurance broker fees | 8 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 4 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,506 | | Total amount of fees paid to insurance company | USD $24 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $24,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $825 | | Amount paid for insurance broker fees | 19 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 5 |
| Insurance contract or identification number | 50000900 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $214 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $159 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 6 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $381 | | Total amount of fees paid to insurance company | USD $5 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $242 | | Amount paid for insurance broker fees | 4 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 7 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $2,431 | | Total amount of fees paid to insurance company | USD $48 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,504 | | Amount paid for insurance broker fees | 38 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 8 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-20 | | Total amount of commissions paid to insurance broker | USD $1,953 | | Total amount of fees paid to insurance company | USD $38 | | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | | Welfare Benefit Premiums Paid to Carrier | USD $40,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,224 | | Amount paid for insurance broker fees | 30 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 9 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,268 | | Total amount of fees paid to insurance company | USD $13 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,737 | | 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 | | Amount paid for insurance broker fees | 10 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061322 |
| Policy instance | 10 |
| Insurance contract or identification number | 061322 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 7 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $2,648 | | Total amount of fees paid to insurance company | USD $5 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 8 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-20 | | Total amount of commissions paid to insurance broker | USD $2,304 | | Total amount of fees paid to insurance company | USD $3 | | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | | Welfare Benefit Premiums Paid to Carrier | USD $38,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 9 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,811 | | Total amount of fees paid to insurance company | USD $4 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061322 |
| Policy instance | 10 |
| Insurance contract or identification number | 061322 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,545 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 6 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $456 | | Total amount of fees paid to insurance company | USD $1 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 5 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $251 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 4 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,953 | | Total amount of fees paid to insurance company | USD $2 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $21,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 3 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $954 | | Total amount of fees paid to insurance company | USD $1 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $12,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028312 |
| Policy instance | 2 |
| Insurance contract or identification number | 028312 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017798 |
| Policy instance | 1 |
| Insurance contract or identification number | 017798 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017798 |
| Policy instance | 9 |
| Insurance contract or identification number | 017798 | | Number of Individuals Covered | 363 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028312 |
| Policy instance | 8 |
| Insurance contract or identification number | 028312 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 7 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,706 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,463 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 6 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,196 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | | Welfare Benefit Premiums Paid to Carrier | USD $37,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,881 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 5 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,455 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,105 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 4 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $448 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $384 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 2 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,567 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $24,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,994 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 3 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 382 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $249 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $210 | | Insurance broker organization code? | 3 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061322 |
| Policy instance | 10 |
| Insurance contract or identification number | 061322 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 1 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,570 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $12,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,217 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 1 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $3,745 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Welfare Benefit Premiums Paid to Carrier | USD $12,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 017798 |
| Policy instance | 9 |
| Insurance contract or identification number | 017798 | | Number of Individuals Covered | 330 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061322 |
| Policy instance | 10 |
| Insurance contract or identification number | 061322 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,653 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 028312 |
| Policy instance | 8 |
| Insurance contract or identification number | 028312 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 6 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,192 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOLUNTARY INCOME PROTECTION | | Welfare Benefit Premiums Paid to Carrier | USD $36,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 7 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,997 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 5 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,465 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 4 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $520 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $8,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 2 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $8,596 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ECR CRITICAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $27,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50000900 |
| Policy instance | 3 |
| Insurance contract or identification number | 50000900 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $250 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $16,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
