QSI, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan QSI, INC. HEALTH AND WELFARE BENEFIT PLAN
401k plan membership statisitcs for QSI, INC. HEALTH AND WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 455 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 577 |
| Total of all active and inactive participants | 2022-07-01 | 577 |
| 2021: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 395 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 455 |
| Total of all active and inactive participants | 2021-07-01 | 455 |
| 2020: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 472 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 395 |
| Total of all active and inactive participants | 2020-07-01 | 395 |
| 2019: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 472 |
| Total of all active and inactive participants | 2019-07-01 | 472 |
| 2018: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 293 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 312 |
| Total of all active and inactive participants | 2018-07-01 | 312 |
| 2017: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 293 |
| Total of all active and inactive participants | 2017-07-01 | 293 |
| Total participants | 2017-07-01 | 293 |
| 2016: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 128 |
| Total of all active and inactive participants | 2016-07-01 | 128 |
| Total participants | 2016-07-01 | 128 |
| 2015: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 185 |
| Total of all active and inactive participants | 2015-07-01 | 185 |
| Total participants | 2015-07-01 | 185 |
| 2022: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: QSI, INC. HEALTH AND WELFARE 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 – General assets of the sponsor | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: QSI, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | First time form 5500 has been submitted | Yes |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0242585 |
| Policy instance | 5 |
| Insurance contract or identification number | 0242585 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $60,164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228617 |
| Policy instance | 4 |
| Insurance contract or identification number | 0228617 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $13,350 | | Total amount of fees paid to insurance company | USD $2,979 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $69,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,350 | | Amount paid for insurance broker fees | 89 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5955759 |
| Policy instance | 3 |
| Insurance contract or identification number | 5955759 | | Number of Individuals Covered | 1174 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $40,576 | | Total amount of fees paid to insurance company | USD $-2,630 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $416,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,576 | | Amount paid for insurance broker fees | 89 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228618 |
| Policy instance | 2 |
| Insurance contract or identification number | 0228618 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $26,489 | | Total amount of fees paid to insurance company | USD $5,851 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $135,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,489 | | Amount paid for insurance broker fees | 89 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2247 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2247 | | Number of Individuals Covered | 1299 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $16,028 | | Total amount of fees paid to insurance company | USD $10,055 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,542,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,028 | | Amount paid for insurance broker fees | 10055 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2247 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2247 | | Number of Individuals Covered | 994 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $689,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228618 |
| Policy instance | 2 |
| Insurance contract or identification number | 0228618 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $25,054 | | Total amount of fees paid to insurance company | USD $7,122 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $118,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,054 | | Amount paid for insurance broker fees | 57 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5955759 |
| Policy instance | 3 |
| Insurance contract or identification number | 5955759 | | Number of Individuals Covered | 1146 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $62,037 | | Total amount of fees paid to insurance company | USD $57,078 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $627,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,037 | | Amount paid for insurance broker fees | 57 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228617 |
| Policy instance | 4 |
| Insurance contract or identification number | 0228617 | | Number of Individuals Covered | 455 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $11,746 | | Total amount of fees paid to insurance company | USD $3,351 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $56,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,746 | | Amount paid for insurance broker fees | 57 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228617 |
| Policy instance | 4 |
| Insurance contract or identification number | 0228617 | | Number of Individuals Covered | 395 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $6,943 | | Total amount of fees paid to insurance company | USD $1,619 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $46,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,210 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5955759 |
| Policy instance | 3 |
| Insurance contract or identification number | 5955759 | | Number of Individuals Covered | 1019 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $31,681 | | Total amount of fees paid to insurance company | USD $32,786 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $591,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,681 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0228618 |
| Policy instance | 2 |
| Insurance contract or identification number | 0228618 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $15,472 | | Total amount of fees paid to insurance company | USD $3,530 | | Other welfare benefits provided | HEALTH INDEMNITY | | Welfare Benefit Premiums Paid to Carrier | USD $104,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,862 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2247 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2247 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $62,836 | | Total amount of fees paid to insurance company | USD $1,619 | | Welfare Benefit Premiums Paid to Carrier | USD $680,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5955759 |
| Policy instance | 3 |
| Insurance contract or identification number | 5955759 | | Number of Individuals Covered | 922 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $46,571 | | Total amount of fees paid to insurance company | USD $50,491 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $524,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,518 | | Amount paid for insurance broker fees | 5947 | | Additional information about fees paid to insurance broker | NON MONETARY AND SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3979887 |
| Policy instance | 2 |
| Insurance contract or identification number | E3979887 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $25,042 | | Total amount of fees paid to insurance company | USD $3,244 | | Other welfare benefits provided | VOLUNTARY ACCIDENT, BRIDGE/HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $141,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,309 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2349 | | Additional information about fees paid to insurance broker | FEES |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | KY2247 |
| Policy instance | 1 |
| Insurance contract or identification number | KY2247 | | Number of Individuals Covered | 792 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $532,146 | | 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 | S15207A |
| Policy instance | 1 |
| Insurance contract or identification number | S15207A | | Number of Individuals Covered | 317 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $4,685 | | Total amount of fees paid to insurance company | USD $70,661 | | Welfare Benefit Premiums Paid to Carrier | USD $375,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 56985 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $4,685 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1027530 |
| Policy instance | 2 |
| Insurance contract or identification number | 1027530 | | Number of Individuals Covered | 607 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $17,917 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $205,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,917 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3979887 |
| Policy instance | 3 |
| Insurance contract or identification number | E3979887 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $26,555 | | Total amount of fees paid to insurance company | USD $6,066 | | Other welfare benefits provided | VOLUNTARY ACCIDENT, BRIDGE/HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $125,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,878 | | Amount paid for insurance broker fees | 4407 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5955759 |
| Policy instance | 4 |
| Insurance contract or identification number | 5955759 | | Number of Individuals Covered | 9312 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $7,710 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $205,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,710 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3979887 |
| Policy instance | 3 |
| Insurance contract or identification number | E3979887 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $25,133 | | Total amount of fees paid to insurance company | USD $8,240 | | Other welfare benefits provided | VOLUNTARY ACCIDENT, BRIDGE/HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $116,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1027530 |
| Policy instance | 2 |
| Insurance contract or identification number | 1027530 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $30,844 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $351,696 | | 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 | SLA15787E |
| Policy instance | 1 |
| Insurance contract or identification number | SLA15787E | | Number of Individuals Covered | 256 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $107,091 | | Welfare Benefit Premiums Paid to Carrier | USD $406,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
