G.A. WINTZER & SON COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN
401k plan membership statisitcs for G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 121 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 122 |
| 2021: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 120 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 121 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 125 |
| Total of all active and inactive participants | 2020-01-01 | 125 |
| 2019: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 122 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 122 |
| 2018: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 118 |
| 2017: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 115 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 56 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 171 |
| 2016: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 109 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 56 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 165 |
| Total participants | 2016-01-01 | 165 |
| 2015: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 102 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 152 |
| Total participants | 2015-01-01 | 152 |
| 2014: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 48 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 155 |
| Total participants | 2014-01-01 | 155 |
| 2013: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 110 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 160 |
| Total participants | 2013-01-01 | 160 |
| 2012: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 108 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 48 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 156 |
| Total participants | 2012-01-01 | 156 |
| 2011: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 102 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 48 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 150 |
| Total participants | 2011-01-01 | 150 |
| 2010: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 101 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 47 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 148 |
| Total participants | 2010-01-01 | 148 |
| 2009: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 92 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 45 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 137 |
| Total participants | 2009-07-01 | 137 |
| 2008: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-07-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-07-01 | 90 |
| Number of retired or separated participants receiving benefits | 2008-07-01 | 45 |
| Number of other retired or separated participants entitled to future benefits | 2008-07-01 | 0 |
| Total of all active and inactive participants | 2008-07-01 | 135 |
| Total participants | 2008-07-01 | 135 |
| 2007: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-07-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-07-01 | 86 |
| Number of retired or separated participants receiving benefits | 2007-07-01 | 47 |
| Number of other retired or separated participants entitled to future benefits | 2007-07-01 | 0 |
| Total of all active and inactive participants | 2007-07-01 | 133 |
| Total participants | 2007-07-01 | 133 |
| 2006: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-07-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-07-01 | 89 |
| Number of retired or separated participants receiving benefits | 2006-07-01 | 43 |
| Number of other retired or separated participants entitled to future benefits | 2006-07-01 | 0 |
| Total of all active and inactive participants | 2006-07-01 | 132 |
| Total participants | 2006-07-01 | 132 |
| 2005: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-07-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-07-01 | 88 |
| Number of retired or separated participants receiving benefits | 2005-07-01 | 41 |
| Number of other retired or separated participants entitled to future benefits | 2005-07-01 | 0 |
| Total of all active and inactive participants | 2005-07-01 | 129 |
| Total participants | 2005-07-01 | 129 |
| 2004: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-07-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-07-01 | 86 |
| Number of retired or separated participants receiving benefits | 2004-07-01 | 42 |
| Number of other retired or separated participants entitled to future benefits | 2004-07-01 | 0 |
| Total of all active and inactive participants | 2004-07-01 | 128 |
| Total participants | 2004-07-01 | 128 |
| 2003: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-07-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-07-01 | 87 |
| Number of retired or separated participants receiving benefits | 2003-07-01 | 46 |
| Number of other retired or separated participants entitled to future benefits | 2003-07-01 | 0 |
| Total of all active and inactive participants | 2003-07-01 | 133 |
| Total participants | 2003-07-01 | 133 |
| 2002: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-07-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-07-01 | 86 |
| Number of retired or separated participants receiving benefits | 2002-07-01 | 47 |
| Number of other retired or separated participants entitled to future benefits | 2002-07-01 | 0 |
| Total of all active and inactive participants | 2002-07-01 | 133 |
| Total participants | 2002-07-01 | 133 |
| 2001: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-07-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-07-01 | 81 |
| Number of retired or separated participants receiving benefits | 2001-07-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 2001-07-01 | 0 |
| Total of all active and inactive participants | 2001-07-01 | 131 |
| Total participants | 2001-07-01 | 131 |
| 2000: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-07-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-07-01 | 78 |
| Number of retired or separated participants receiving benefits | 2000-07-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 2000-07-01 | 0 |
| Total of all active and inactive participants | 2000-07-01 | 128 |
| Total participants | 2000-07-01 | 128 |
| 1999: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1999 401k membership |
|---|
| Total participants, beginning-of-year | 1999-07-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 1999-07-01 | 78 |
| Number of retired or separated participants receiving benefits | 1999-07-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 1999-07-01 | 0 |
| Total of all active and inactive participants | 1999-07-01 | 128 |
| Total participants | 1999-07-01 | 128 |
| 1998: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-07-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-07-01 | 77 |
| Number of retired or separated participants receiving benefits | 1998-07-01 | 53 |
| Number of other retired or separated participants entitled to future benefits | 1998-07-01 | 0 |
| Total of all active and inactive participants | 1998-07-01 | 130 |
| Total participants | 1998-07-01 | 130 |
| 1997: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1997 401k membership |
|---|
| Total participants, beginning-of-year | 1997-07-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 1997-07-01 | 70 |
| Number of retired or separated participants receiving benefits | 1997-07-01 | 48 |
| Number of other retired or separated participants entitled to future benefits | 1997-07-01 | 0 |
| Total of all active and inactive participants | 1997-07-01 | 118 |
| Total participants | 1997-07-01 | 118 |
| 1996: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1996 401k membership |
|---|
| Total participants, beginning-of-year | 1996-07-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 1996-07-01 | 71 |
| Number of retired or separated participants receiving benefits | 1996-07-01 | 49 |
| Number of other retired or separated participants entitled to future benefits | 1996-07-01 | 0 |
| Total of all active and inactive participants | 1996-07-01 | 120 |
| Total participants | 1996-07-01 | 120 |
| 1995: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1995 401k membership |
|---|
| Total participants, beginning-of-year | 1995-07-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 1995-07-01 | 70 |
| Number of retired or separated participants receiving benefits | 1995-07-01 | 49 |
| Number of other retired or separated participants entitled to future benefits | 1995-07-01 | 0 |
| Total of all active and inactive participants | 1995-07-01 | 119 |
| Total participants | 1995-07-01 | 119 |
| 1994: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1994 401k membership |
|---|
| Total participants, beginning-of-year | 1994-07-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 1994-07-01 | 75 |
| Number of retired or separated participants receiving benefits | 1994-07-01 | 50 |
| Number of other retired or separated participants entitled to future benefits | 1994-07-01 | 0 |
| Total of all active and inactive participants | 1994-07-01 | 125 |
| Total participants | 1994-07-01 | 125 |
| 1993: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1993 401k membership |
|---|
| Total participants, beginning-of-year | 1993-07-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 1993-07-01 | 74 |
| Number of retired or separated participants receiving benefits | 1993-07-01 | 51 |
| Number of other retired or separated participants entitled to future benefits | 1993-07-01 | 0 |
| Total of all active and inactive participants | 1993-07-01 | 125 |
| Total participants | 1993-07-01 | 125 |
| 1992: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1992 401k membership |
|---|
| Total participants, beginning-of-year | 1992-07-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 1992-07-01 | 75 |
| Number of retired or separated participants receiving benefits | 1992-07-01 | 49 |
| Number of other retired or separated participants entitled to future benefits | 1992-07-01 | 0 |
| Total of all active and inactive participants | 1992-07-01 | 124 |
| Total participants | 1992-07-01 | 124 |
| 1991: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1991 401k membership |
|---|
| Total participants, beginning-of-year | 1991-07-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 1991-07-01 | 73 |
| Number of retired or separated participants receiving benefits | 1991-07-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 1991-07-01 | 0 |
| Total of all active and inactive participants | 1991-07-01 | 117 |
| Total participants | 1991-07-01 | 117 |
| 1990: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1990 401k membership |
|---|
| Total participants, beginning-of-year | 1990-07-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 1990-07-01 | 78 |
| Number of retired or separated participants receiving benefits | 1990-07-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 1990-07-01 | 0 |
| Total of all active and inactive participants | 1990-07-01 | 122 |
| Total participants | 1990-07-01 | 122 |
| 1989: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1989 401k membership |
|---|
| Total participants, beginning-of-year | 1989-07-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 1989-07-01 | 72 |
| Number of retired or separated participants receiving benefits | 1989-07-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 1989-07-01 | 0 |
| Total of all active and inactive participants | 1989-07-01 | 116 |
| Total participants | 1989-07-01 | 116 |
| 1988: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1988 401k membership |
|---|
| Total participants, beginning-of-year | 1988-07-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 1988-07-01 | 72 |
| Number of retired or separated participants receiving benefits | 1988-07-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 1988-07-01 | 0 |
| Total of all active and inactive participants | 1988-07-01 | 116 |
| Total participants | 1988-07-01 | 116 |
| Measure | Date | Value |
|---|
| 2022 : G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $0 |
| Total income from all sources (including contributions) | 2022-12-31 | $2,168,408 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $2,395,313 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $2,311,344 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $2,348,674 |
| Value of total assets at end of year | 2022-12-31 | $2,150,216 |
| Value of total assets at beginning of year | 2022-12-31 | $2,377,121 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $83,969 |
| Total interest from all sources | 2022-12-31 | $43,536 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $83,969 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $285,095 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $100,275 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $144,538 |
| Total non interest bearing cash at end of year | 2022-12-31 | $170,488 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $161,975 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-226,905 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $2,150,216 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $2,377,121 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $1,808,611 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $1,785,778 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $70,842 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $284,830 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $284,830 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $43,536 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $1,123,318 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-223,802 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $2,063,579 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $1,188,026 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm EIN | 2022-12-31 | 310800053 |
| 2021 : G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2021 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2021-12-31 | $52,740 |
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $52,740 |
| Total income from all sources (including contributions) | 2021-12-31 | $2,487,686 |
| Total of all expenses incurred | 2021-12-31 | $2,237,466 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $2,167,072 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $2,406,756 |
| Value of total assets at end of year | 2021-12-31 | $2,377,121 |
| Value of total assets at beginning of year | 2021-12-31 | $2,126,901 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $70,394 |
| Total interest from all sources | 2021-12-31 | $28,190 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $70,394 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $266,549 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $144,538 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $75,358 |
| Total non interest bearing cash at end of year | 2021-12-31 | $161,975 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $53,952 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $250,220 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $2,377,121 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $2,126,901 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $1,785,778 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $284,830 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $1,997,591 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $1,997,591 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $28,190 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $973,640 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $2,140,207 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $1,193,432 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm EIN | 2021-12-31 | 310800053 |
| 2020 : G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2020 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2020-12-31 | $6,873 |
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $6,873 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $0 |
| Total income from all sources (including contributions) | 2020-12-31 | $2,315,743 |
| Total loss/gain on sale of assets | 2020-12-31 | $0 |
| Total of all expenses incurred | 2020-12-31 | $2,340,978 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $2,272,288 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $2,288,569 |
| Value of total assets at end of year | 2020-12-31 | $2,126,901 |
| Value of total assets at beginning of year | 2020-12-31 | $2,152,136 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $68,690 |
| Total interest from all sources | 2020-12-31 | $20,301 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $68,690 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $251,728 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $75,358 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $127,321 |
| Total non interest bearing cash at end of year | 2020-12-31 | $53,952 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $2,024,815 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-25,235 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $2,126,901 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $2,152,136 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $1,997,591 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $20,301 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $872,312 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $2,036,841 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $1,399,976 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm EIN | 2020-12-31 | 310800053 |
| 2019 : G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $0 |
| Total income from all sources (including contributions) | 2019-12-31 | $2,542,254 |
| Total income from all sources (including contributions) | 2019-12-31 | $2,542,254 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total of all expenses incurred | 2019-12-31 | $2,431,788 |
| Total of all expenses incurred | 2019-12-31 | $2,431,788 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $2,366,700 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $2,366,700 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $2,532,344 |
| Value of total assets at end of year | 2019-12-31 | $2,152,136 |
| Value of total assets at end of year | 2019-12-31 | $2,152,136 |
| Value of total assets at beginning of year | 2019-12-31 | $2,041,670 |
| Value of total assets at beginning of year | 2019-12-31 | $2,041,670 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $65,088 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $65,088 |
| Total interest from all sources | 2019-12-31 | $9,910 |
| Total interest from all sources | 2019-12-31 | $9,910 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $65,088 |
| Administrative expenses professional fees incurred | 2019-12-31 | $65,088 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $223,602 |
| Contributions received from participants | 2019-12-31 | $223,602 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $127,321 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $127,321 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $60,459 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $60,459 |
| Total non interest bearing cash at end of year | 2019-12-31 | $2,024,815 |
| Total non interest bearing cash at end of year | 2019-12-31 | $2,024,815 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $1,981,211 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $1,981,211 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $110,466 |
| Value of net income/loss | 2019-12-31 | $110,466 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $2,152,136 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $2,152,136 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $2,041,670 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $2,041,670 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $9,910 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $863,902 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $863,902 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $2,308,742 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $1,502,798 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $1,502,798 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm name | 2019-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm EIN | 2019-12-31 | 310800053 |
| Accountancy firm EIN | 2019-12-31 | 310800053 |
| 2018 : G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $0 |
| Total income from all sources (including contributions) | 2018-12-31 | $1,747,888 |
| Total loss/gain on sale of assets | 2018-12-31 | $0 |
| Total of all expenses incurred | 2018-12-31 | $1,744,536 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $1,684,156 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $1,744,536 |
| Value of total assets at end of year | 2018-12-31 | $1,981,211 |
| Value of total assets at beginning of year | 2018-12-31 | $1,977,859 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $60,380 |
| Total interest from all sources | 2018-12-31 | $3,352 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Was this plan covered by a fidelity bond | 2018-12-31 | No |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $194,780 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $60,459 |
| Total non interest bearing cash at end of year | 2018-12-31 | $1,981,211 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $1,977,859 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $3,352 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $1,981,211 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $1,977,859 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $3,352 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $803,380 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $1,549,756 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $880,776 |
| Contract administrator fees | 2018-12-31 | $60,380 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $0 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | CLARK, SCHAEFER, HACKETT & CO. |
| Accountancy firm EIN | 2018-12-31 | 310800053 |
| 2022: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | Yes |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2008 form 5500 responses |
|---|
| 2008-07-01 | Type of plan entity | Single employer plan |
| 2008-07-01 | Plan funding arrangement – Insurance | Yes |
| 2008-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2007 form 5500 responses |
|---|
| 2007-07-01 | Type of plan entity | Single employer plan |
| 2007-07-01 | Plan funding arrangement – Insurance | Yes |
| 2007-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2006 form 5500 responses |
|---|
| 2006-07-01 | Type of plan entity | Single employer plan |
| 2006-07-01 | Plan funding arrangement – Insurance | Yes |
| 2006-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2005 form 5500 responses |
|---|
| 2005-07-01 | Type of plan entity | Single employer plan |
| 2005-07-01 | Plan funding arrangement – Insurance | Yes |
| 2005-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2004 form 5500 responses |
|---|
| 2004-07-01 | Type of plan entity | Single employer plan |
| 2004-07-01 | Plan funding arrangement – Insurance | Yes |
| 2004-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2003 form 5500 responses |
|---|
| 2003-07-01 | Type of plan entity | Single employer plan |
| 2003-07-01 | Plan funding arrangement – Insurance | Yes |
| 2003-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2002 form 5500 responses |
|---|
| 2002-07-01 | Type of plan entity | Single employer plan |
| 2002-07-01 | Plan funding arrangement – Insurance | Yes |
| 2002-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2001: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2001 form 5500 responses |
|---|
| 2001-07-01 | Type of plan entity | Single employer plan |
| 2001-07-01 | Plan funding arrangement – Insurance | Yes |
| 2001-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2001-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2001-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2000: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 2000 form 5500 responses |
|---|
| 2000-07-01 | Type of plan entity | Single employer plan |
| 2000-07-01 | Plan funding arrangement – Insurance | Yes |
| 2000-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2000-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2000-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1999: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1999 form 5500 responses |
|---|
| 1999-07-01 | Type of plan entity | Single employer plan |
| 1999-07-01 | Plan funding arrangement – Insurance | Yes |
| 1999-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1999-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1999-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1998: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1998 form 5500 responses |
|---|
| 1998-07-01 | Type of plan entity | Single employer plan |
| 1998-07-01 | Plan funding arrangement – Insurance | Yes |
| 1998-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1998-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1998-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1997: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1997 form 5500 responses |
|---|
| 1997-07-01 | Type of plan entity | Single employer plan |
| 1997-07-01 | Plan funding arrangement – Insurance | Yes |
| 1997-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1997-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1997-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1996: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1996 form 5500 responses |
|---|
| 1996-07-01 | Type of plan entity | Single employer plan |
| 1996-07-01 | Plan funding arrangement – Insurance | Yes |
| 1996-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1996-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1996-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1995: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1995 form 5500 responses |
|---|
| 1995-07-01 | Type of plan entity | Single employer plan |
| 1995-07-01 | Plan funding arrangement – Insurance | Yes |
| 1995-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1995-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1995-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1994: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1994 form 5500 responses |
|---|
| 1994-07-01 | Type of plan entity | Single employer plan |
| 1994-07-01 | Plan funding arrangement – Insurance | Yes |
| 1994-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1994-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1994-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1993: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1993 form 5500 responses |
|---|
| 1993-07-01 | Type of plan entity | Single employer plan |
| 1993-07-01 | Plan funding arrangement – Insurance | Yes |
| 1993-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1993-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1993-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1992: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1992 form 5500 responses |
|---|
| 1992-07-01 | Type of plan entity | Single employer plan |
| 1992-07-01 | Plan funding arrangement – Insurance | Yes |
| 1992-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1992-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1992-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1991: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1991 form 5500 responses |
|---|
| 1991-07-01 | Type of plan entity | Single employer plan |
| 1991-07-01 | Plan funding arrangement – Insurance | Yes |
| 1991-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1991-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1991-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1990: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1990 form 5500 responses |
|---|
| 1990-07-01 | Type of plan entity | Single employer plan |
| 1990-07-01 | Plan funding arrangement – Insurance | Yes |
| 1990-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1990-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1990-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1989: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1989 form 5500 responses |
|---|
| 1989-07-01 | Type of plan entity | Single employer plan |
| 1989-07-01 | Plan funding arrangement – Insurance | Yes |
| 1989-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1989-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1989-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1988: G A WINTZER & SON COMPANY HEALTH AND WELFARE BENEFITS PLAN 1988 form 5500 responses |
|---|
| 1988-07-01 | Type of plan entity | Single employer plan |
| 1988-07-01 | First time form 5500 has been submitted | Yes |
| 1988-07-01 | Plan funding arrangement – Insurance | Yes |
| 1988-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1988-07-01 | Plan benefit arrangement – Insurance | Yes |
| 1988-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 506493 |
| Policy instance | 2 |
| Insurance contract or identification number | 506493 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $12,304 | | Total amount of fees paid to insurance company | USD $2,488 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, CANCER, ACCIDENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $106,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,304 | | Amount paid for insurance broker fees | 2488 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 6238 |
| Policy instance | 7 |
| Insurance contract or identification number | 6238 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $13,392 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $138,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,940 | | Insurance broker organization code? | 5 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 849768 |
| Policy instance | 6 |
| Insurance contract or identification number | 849768 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,343 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $39,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,343 | | Insurance broker organization code? | 3 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 5 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 63 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $19,206 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $108,830 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,804 | | Insurance broker organization code? | 5 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40064 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40064 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,783 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,783 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL35062 |
| Policy instance | 3 |
| Insurance contract or identification number | HCL35062 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $70,964 | | Total amount of fees paid to insurance company | USD $3,832 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $709,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,964 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3832 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30044866 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,158 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,065 | | Insurance broker organization code? | 3 |
|
| AMERITAS INSURANCE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | 010 |
| Policy instance | 8 |
| Insurance contract or identification number | 010 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,312 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $531 | | Insurance broker organization code? | 5 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 506493 |
| Policy instance | 2 |
| Insurance contract or identification number | 506493 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,871 | | Total amount of fees paid to insurance company | USD $6,267 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $82,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,871 | | Amount paid for insurance broker fees | 6267 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30044866 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $870 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $870 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | SL-849768 |
| Policy instance | 6 |
| Insurance contract or identification number | SL-849768 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $38,709 | | 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 | 920303 |
| Policy instance | 3 |
| Insurance contract or identification number | 920303 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $612,391 | | 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 | HCCLOT40064 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40064 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $66,355 | | Total amount of fees paid to insurance company | USD $3,430 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $663,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,992 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 5 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 63 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $17,742 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,539 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,828 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 5 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 6238 |
| Policy instance | 7 |
| Insurance contract or identification number | 6238 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,990 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $128,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,642 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 5 |
|
| AMERITAS INSURANCE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | 10 |
| Policy instance | 8 |
| Insurance contract or identification number | 10 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,104 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $447 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 5 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 9058 |
| Policy instance | 3 |
| Insurance contract or identification number | 9058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $71 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY BENEFITS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19 | | Insurance broker organization code? | 3 |
|
| AMERITAS INSURANCE (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | 010 |
| Policy instance | 2 |
| Insurance contract or identification number | 010 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $824 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $348 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | SL-849768 |
| Policy instance | 1 |
| Insurance contract or identification number | SL-849768 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,318 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $38,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,318 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30044866 |
| Policy instance | 10 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $987 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $987 | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 6238 |
| Policy instance | 4 |
| Insurance contract or identification number | 6238 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $13,200 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $124,240 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,798 | | Insurance broker organization code? | 5 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00506493 |
| Policy instance | 5 |
| Insurance contract or identification number | 00506493 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,736 | | Total amount of fees paid to insurance company | USD $4,754 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, VOLUNTARY CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $82,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,736 | | Amount paid for insurance broker fees | 4754 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | |
| Policy instance | 6 |
| Number of Individuals Covered | 125 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $533,245 | | 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 | HCL35062 |
| Policy instance | 7 |
| Insurance contract or identification number | HCL35062 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $50,660 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $506,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,660 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40064 |
| Policy instance | 8 |
| Insurance contract or identification number | HCCLOT40064 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,665 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $26,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,665 | | Insurance broker organization code? | 3 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 9 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 62 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $17,170 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $97,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,447 | | Insurance broker organization code? | 5 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 7 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 62 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $15,766 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $89,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,511 | | Insurance broker organization code? | 5 |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 ) |
| Policy contract number | 149154 |
| Policy instance | 6 |
| Insurance contract or identification number | 149154 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $850 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TELEMEDICINE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $850 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 920303 |
| Policy instance | 5 |
| Insurance contract or identification number | 920303 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $500,573 | | 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 Covered | 122 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $25,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00506493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00506493 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,684 | | Total amount of fees paid to insurance company | USD $4,493 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, VOLUNTARY CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $73,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,684 | | Amount paid for insurance broker fees | 4493 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 6238 |
| Policy instance | 2 |
| Insurance contract or identification number | 6238 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $12,484 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $111,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,266 | | Insurance broker organization code? | 5 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | SL-849768 |
| Policy instance | 1 |
| Insurance contract or identification number | SL-849768 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $37,957 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30044866 |
| Policy instance | 8 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $955 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $955 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30044866 |
| Policy instance | 9 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $890 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $890 | | Insurance broker organization code? | 3 |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 ) |
| Policy contract number | 149154 |
| Policy instance | 7 |
| Insurance contract or identification number | 149154 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $821 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | TELEMEDICINE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $821 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | |
| Policy instance | 6 |
| Number of Individuals Covered | 116 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $26,019 | | 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 | 9475479 |
| Policy instance | 5 |
| Insurance contract or identification number | 9475479 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,600 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $25,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,600 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00506493 |
| Policy instance | 4 |
| Insurance contract or identification number | 00506493 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $8,109 | | Total amount of fees paid to insurance company | USD $4,558 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, VOLUNTARY CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $68,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,109 | | Amount paid for insurance broker fees | 4558 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 116 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $513,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000009058 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000009058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $115 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32 | | Insurance broker organization code? | 3 |
|
| STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579114 |
| Policy instance | 1 |
| Insurance contract or identification number | S9579114 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,451 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $116,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,284 | | Insurance broker organization code? | 3 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 8 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 58 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,301 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $81,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,767 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30044866 |
| Policy instance | 1 |
| Insurance contract or identification number | 30044866 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $822 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $822 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT STRATEGIES AGENCY LLC |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 ) |
| Policy contract number | 149154 |
| Policy instance | 2 |
| Insurance contract or identification number | 149154 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $811 | | Welfare Benefit Premiums Paid to Carrier | USD $5,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $811 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT STRATEGIES AGENCY LLC |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0927464H0000A |
| Policy instance | 3 |
| Insurance contract or identification number | MZ0927464H0000A | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,587 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $76,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,058 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITS STRATEGIES AGENCY LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | SLM540181 |
| Policy instance | 4 |
| Insurance contract or identification number | SLM540181 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $41,671 | | Welfare Benefit Premiums Paid to Carrier | USD $103,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,671 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT STRATEGIES AGENCY LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00506493 |
| Policy instance | 5 |
| Insurance contract or identification number | 00506493 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $8,317 | | Total amount of fees paid to insurance company | USD $439 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,317 | | Amount paid for insurance broker fees | 439 | | Additional information about fees paid to insurance broker | BONUS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT STRATEGIES AGENCY LLC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | SL-849768 |
| Policy instance | 6 |
| Insurance contract or identification number | SL-849768 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,696 | | Welfare Benefit Premiums Paid to Carrier | USD $42,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,696 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT STRATEGIES AGENCY LLC |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-1869 |
| Policy instance | 7 |
| Insurance contract or identification number | 947-1869 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,532 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $25,295 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,532 | | Insurance broker name | BENEFIT STRATEGIES AGENCY |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000009058 |
| Policy instance | 8 |
| Insurance contract or identification number | 0000009058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $105 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41 | | Insurance broker organization code? | 3 | | Insurance broker name | IAN B BRANYON |
|
| STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579114 |
| Policy instance | 9 |
| Insurance contract or identification number | S9579114 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,081 | | Welfare Benefit Premiums Paid to Carrier | USD $105,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,108 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITS STRATEGIES AGENCY LLC |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-4001 |
| Policy instance | 1 |
| Insurance contract or identification number | 949-4001 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $39,034 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $325,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,034 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00434698 |
| Policy instance | 2 |
| Insurance contract or identification number | 00434698 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,083 | | 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 $47,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,083 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000009058 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000009058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,526 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,506 | | Insurance broker organization code? | 3 | | Insurance broker name | CHRIS D BOULDREY |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 2768 |
| Policy instance | 4 |
| Insurance contract or identification number | 2768 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,482 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $76,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,988 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D2768 |
| Policy instance | 5 |
| Insurance contract or identification number | D2768 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,211 | | Welfare Benefit Premiums Paid to Carrier | USD $64,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,408 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-9557 |
| Policy instance | 1 |
| Insurance contract or identification number | 280-9557 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $42,306 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $289,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,306 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00434696 |
| Policy instance | 2 |
| Insurance contract or identification number | 00434696 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,778 | | Total amount of fees paid to insurance company | USD $2,571 | | 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 $45,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,778 | | Amount paid for insurance broker fees | 2571 | | Additional information about fees paid to insurance broker | BONUS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000009058 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000009058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,456 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,289 | | Insurance broker organization code? | 3 | | Insurance broker name | CHRIS D BOULDREY |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 2768 |
| Policy instance | 4 |
| Insurance contract or identification number | 2768 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $10,654 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $60,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,103 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
|
| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D2768 |
| Policy instance | 5 |
| Insurance contract or identification number | D2768 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,128 | | Welfare Benefit Premiums Paid to Carrier | USD $97,424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,564 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-9557 |
| Policy instance | 1 |
| Insurance contract or identification number | 280-9557 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $34,095 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $227,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,095 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00434698 |
| Policy instance | 2 |
| Insurance contract or identification number | 00434698 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,733 | | Total amount of fees paid to insurance company | USD $2,692 | | 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 $43,914 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,630 | | Amount paid for insurance broker fees | 2692 | | Additional information about fees paid to insurance broker | BONUS COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | LUCIDO MORRIS & ASSOCIATES |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000009058 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000009058 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $16,506 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,622 | | Insurance broker organization code? | 3 | | Insurance broker name | INGER M PENNINGTON |
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| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 2768 |
| Policy instance | 4 |
| Insurance contract or identification number | 2768 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,092 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,728 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
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| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D2768 |
| Policy instance | 5 |
| Insurance contract or identification number | D2768 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,824 | | Welfare Benefit Premiums Paid to Carrier | USD $91,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,412 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
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| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | D2768 |
| Policy instance | 4 |
| Insurance contract or identification number | D2768 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,474 | | Welfare Benefit Premiums Paid to Carrier | USD $85,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,237 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE |
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| UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 ) |
| Policy contract number | 2768 |
| Policy instance | 3 |
| Insurance contract or identification number | 2768 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $10,055 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,977 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,703 | | Insurance broker organization code? | 3 | | Insurance broker name | AMWINS |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00434698 |
| Policy instance | 2 |
| Insurance contract or identification number | 00434698 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,600 | | 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 $41,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,492 | | Insurance broker organization code? | 3 | | Insurance broker name | LUCIDO MORRIS & ASSOCIATES |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-9557 |
| Policy instance | 1 |
| Insurance contract or identification number | 280-9557 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $36,537 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $243,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,537 | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC |
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