| Insurance contract or identification number | GLUG0C4MM |
| Number of Individuals Covered | 112 |
| Insurance policy start date | 2023-05-01 |
| Insurance policy end date | 2024-04-30 |
| Total amount of commissions paid to insurance broker | USD $4,484 |
| Total amount of fees paid to insurance company | USD $1,217 |
| Health Insurance Welfare Benefit | No |
| Dental Insurance Welfare Benefit | No |
| Vision Insurance Welfare Benefit | No |
| Life Insurance Welfare Benefit | Yes |
| Temporary Disability Insurance Welfare Benefit | No |
| Long Term Disability Insurance Welfare Benefit | No |
| Unemployment Insurance Welfare Benefit | No |
| Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT |
| Welfare Benefit Premiums Paid to Carrier | USD $31,721 |
| Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |