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BALLINGER INDUSTRIES EMPLOYEE BENEFIT 401k Plan overview

Plan NameBALLINGER INDUSTRIES EMPLOYEE BENEFIT
Plan identification number 501

BALLINGER INDUSTRIES EMPLOYEE BENEFIT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

BALLINGER INDUSTRIES INC has sponsored the creation of one or more 401k plans.

Company Name:BALLINGER INDUSTRIES INC
Employer identification number (EIN):341818436
NAIC Classification:333900

Additional information about BALLINGER INDUSTRIES INC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0994246

More information about BALLINGER INDUSTRIES INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BALLINGER INDUSTRIES EMPLOYEE BENEFIT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01TIMOTHY A. JONES, CPA, CGMA
5012016-01-01TIMOTHY A. JONES, CPA, CGMA
5012015-01-01TIMOTHY A. JONES, CPA, CGMA
5012014-01-01TIMOTHY A. JONES, CPA, CGMA
5012013-01-01TIMOTHY A. JONES, CPA, CGMA
5012012-01-01TIMOTHY A. JONES, CPA, CGMA

Plan Statistics for BALLINGER INDUSTRIES EMPLOYEE BENEFIT

401k plan membership statisitcs for BALLINGER INDUSTRIES EMPLOYEE BENEFIT

Measure Date Value
2022: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2022 401k membership
Total participants, beginning-of-year2022-01-01231
Total number of active participants reported on line 7a of the Form 55002022-01-01248
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01250
2021: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2021 401k membership
Total participants, beginning-of-year2021-01-01247
Total number of active participants reported on line 7a of the Form 55002021-01-01230
Number of retired or separated participants receiving benefits2021-01-012
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01232
2020: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2020 401k membership
Total participants, beginning-of-year2020-01-01282
Total number of active participants reported on line 7a of the Form 55002020-01-01247
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01248
2019: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2019 401k membership
Total participants, beginning-of-year2019-01-01291
Total number of active participants reported on line 7a of the Form 55002019-01-01282
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01283
2018: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2018 401k membership
Total participants, beginning-of-year2018-01-01279
Total number of active participants reported on line 7a of the Form 55002018-01-01291
Number of retired or separated participants receiving benefits2018-01-013
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01294
2017: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2017 401k membership
Total participants, beginning-of-year2017-01-01251
Total number of active participants reported on line 7a of the Form 55002017-01-01279
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01280
2016: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2016 401k membership
Total participants, beginning-of-year2016-01-01222
Total number of active participants reported on line 7a of the Form 55002016-01-01251
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01252
2015: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2015 401k membership
Total participants, beginning-of-year2015-01-01221
Total number of active participants reported on line 7a of the Form 55002015-01-01222
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01223
2014: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2014 401k membership
Total participants, beginning-of-year2014-01-01177
Total number of active participants reported on line 7a of the Form 55002014-01-01221
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01222
2013: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2013 401k membership
Total participants, beginning-of-year2013-01-01178
Total number of active participants reported on line 7a of the Form 55002013-01-01177
Number of retired or separated participants receiving benefits2013-01-011
Total of all active and inactive participants2013-01-01178
2012: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2012 401k membership
Total participants, beginning-of-year2012-01-01155
Total number of active participants reported on line 7a of the Form 55002012-01-01178
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-01180

Form 5500 Responses for BALLINGER INDUSTRIES EMPLOYEE BENEFIT

2022: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: BALLINGER INDUSTRIES EMPLOYEE BENEFIT 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40190
Policy instance 4
Insurance contract or identification numberHCCLOT40190
Number of Individuals Covered249
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,471
Other welfare benefits providedORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,471
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number
Policy instance 3
Number of Individuals Covered248
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered305
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,892
Total amount of fees paid to insurance companyUSD $3,470
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,892
Amount paid for insurance broker fees3470
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered248
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered237
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,628
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered288
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,858
Total amount of fees paid to insurance companyUSD $1,097
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $178,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,291
Amount paid for insurance broker fees1097
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberLGS01627-19
Policy instance 3
Insurance contract or identification numberLGS01627-19
Number of Individuals Covered237
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40190
Policy instance 4
Insurance contract or identification numberHCCLOT40190
Number of Individuals Covered126
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,915
Other welfare benefits providedORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,712
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberLGS01627-19
Policy instance 3
Insurance contract or identification numberLGS01627-19
Number of Individuals Covered250
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered268
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,091
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,091
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered250
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number
Policy instance 4
Number of Individuals Covered260
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberLGS01627-19
Policy instance 3
Insurance contract or identification numberLGS01627-19
Number of Individuals Covered260
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered283
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,409
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,409
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered260
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number
Policy instance 4
Number of Individuals Covered263
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract number
Policy instance 3
Number of Individuals Covered263
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered263
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered288
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,294
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,294
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered234
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $40,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,250
Insurance broker organization code?3
Insurance broker nameBENEFIT STRATEGIES AGENCY, LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered264
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,063
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,063
Insurance broker organization code?3
Insurance broker nameBENEFIT STRATEGIES AGENCY, LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1051005
Policy instance 2
Insurance contract or identification number1051005
Number of Individuals Covered254
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,810
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,810
Insurance broker organization code?3
Insurance broker nameBENEFIT STRATEGIES AGENCY, LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberSL-849766
Policy instance 1
Insurance contract or identification numberSL-849766
Number of Individuals Covered245
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $42,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,984
Insurance broker organization code?3
Insurance broker nameBENEFIT STRATEGIES AGENCY, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129561
Policy instance 2
Insurance contract or identification number129561
Number of Individuals Covered193
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,946
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $12,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,946
Insurance broker organization code?3
Insurance broker nameNORTHWEST GROUP SERVICES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number475539
Policy instance 1
Insurance contract or identification number475539
Number of Individuals Covered84
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $2,829
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,774
Insurance broker organization code?3
Insurance broker nameLUCIDO MORRIS ASSOCIATES
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberN04954063003
Policy instance 3
Insurance contract or identification numberN04954063003
Number of Individuals Covered214
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649587
Policy instance 4
Insurance contract or identification number649587
Number of Individuals Covered84
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $858
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $858
Insurance broker organization code?3
Insurance broker nameNORTHWEST WORKSITE MARKETING CORP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number475539
Policy instance 5
Insurance contract or identification number475539
Number of Individuals Covered97
Insurance policy start date2014-02-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,866
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,810
Insurance broker organization code?3
Insurance broker nameLUCIDO MORRIS ASSOCIATES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649587
Policy instance 6
Insurance contract or identification number649587
Number of Individuals Covered94
Insurance policy start date2014-02-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $870
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $870
Insurance broker organization code?3
Insurance broker nameNORTHWEST WORKSITE MARKETING CORP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000CU508
Policy instance 1
Insurance contract or identification number000CU508
Number of Individuals Covered83
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,949
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,743
Insurance broker organization code?3
Insurance broker nameLUCIDO MORRIS ASSOCIATES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129561
Policy instance 2
Insurance contract or identification number129561
Number of Individuals Covered164
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,939
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $15,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,939
Insurance broker organization code?3
Insurance broker nameNORTHWEST GROUP SERVICES
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberN04954063001
Policy instance 3
Insurance contract or identification numberN04954063001
Number of Individuals Covered180
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649587
Policy instance 4
Insurance contract or identification number649587
Number of Individuals Covered84
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $853
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $853
Insurance broker organization code?3
Insurance broker nameNORTHWEST WORKSITE MARKETING CORP
ACE AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22667 )
Policy contract numberN04954063001
Policy instance 3
Insurance contract or identification numberN04954063001
Number of Individuals Covered200
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $76,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,439
Insurance broker organization code?3
Insurance broker nameHUNTINGTON INSURANCE INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number129561
Policy instance 2
Insurance contract or identification number129561
Number of Individuals Covered174
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,747
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $14,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,747
Insurance broker organization code?3
Insurance broker nameNORTHWEST GROUP SERVICES
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number2FABC208
Policy instance 1
Insurance contract or identification number2FABC208
Number of Individuals Covered79
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $8,860
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,860
Insurance broker organization code?3
Insurance broker nameNORTHWEST WORKSITE MARKETING CO

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