LACROIX PRECISION OPTICS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LACROIX OPTICAL COMPANY HEALTH
| Measure | Date | Value |
|---|
| 2022: LACROIX OPTICAL COMPANY HEALTH 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 111 |
| Total of all active and inactive participants | 2022-10-01 | 111 |
| Total participants | 2022-10-01 | 111 |
| Total participants, beginning-of-year | 2022-04-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 118 |
| Total of all active and inactive participants | 2022-04-01 | 118 |
| Total participants | 2022-04-01 | 118 |
| 2021: LACROIX OPTICAL COMPANY HEALTH 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 204 |
| Total of all active and inactive participants | 2021-04-01 | 204 |
| Total participants | 2021-04-01 | 204 |
| 2020: LACROIX OPTICAL COMPANY HEALTH 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 112 |
| Total of all active and inactive participants | 2020-04-01 | 112 |
| Total participants | 2020-04-01 | 112 |
| 2019: LACROIX OPTICAL COMPANY HEALTH 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 107 |
| Total of all active and inactive participants | 2019-04-01 | 107 |
| Total participants | 2019-04-01 | 107 |
| 2018: LACROIX OPTICAL COMPANY HEALTH 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 101 |
| Total of all active and inactive participants | 2018-04-01 | 101 |
| Total participants | 2018-04-01 | 101 |
| 2017: LACROIX OPTICAL COMPANY HEALTH 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 99 |
| Total of all active and inactive participants | 2017-04-01 | 99 |
| Total participants | 2017-04-01 | 99 |
| 2016: LACROIX OPTICAL COMPANY HEALTH 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 83 |
| Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
| Total of all active and inactive participants | 2016-04-01 | 83 |
| Total participants | 2016-04-01 | 83 |
| 2015: LACROIX OPTICAL COMPANY HEALTH 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 0 |
| Total participants | 2015-06-01 | 0 |
| 2014: LACROIX OPTICAL COMPANY HEALTH 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 87 |
| Total of all active and inactive participants | 2014-06-01 | 87 |
| Total participants | 2014-06-01 | 87 |
| 2013: LACROIX OPTICAL COMPANY HEALTH 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 180 |
| Total of all active and inactive participants | 2013-06-01 | 180 |
| Total participants | 2013-06-01 | 180 |
| 2012: LACROIX OPTICAL COMPANY HEALTH 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 97 |
| Total of all active and inactive participants | 2012-06-01 | 97 |
| Total participants | 2012-06-01 | 97 |
| 2011: LACROIX OPTICAL COMPANY HEALTH 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 99 |
| Total of all active and inactive participants | 2011-06-01 | 99 |
| Total participants | 2011-06-01 | 99 |
| 2010: LACROIX OPTICAL COMPANY HEALTH 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 92 |
| Total of all active and inactive participants | 2010-06-01 | 92 |
| Total participants | 2010-06-01 | 92 |
| 2009: LACROIX OPTICAL COMPANY HEALTH 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 107 |
| Total of all active and inactive participants | 2009-06-01 | 107 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 7 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $5,949 | | Total amount of fees paid to insurance company | USD $1,319 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1319 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417002415901 |
| Policy instance | 1 |
| Insurance contract or identification number | 417002415901 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-10-01 | | Total amount of commissions paid to insurance broker | USD $27,160 | | Total amount of fees paid to insurance company | USD $115,752 | | Welfare Benefit Premiums Paid to Carrier | USD $355,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 115752 | | Additional information about fees paid to insurance broker | CLAIMS PROCESSING | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $27,160 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 3 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 4 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $1,652 | | Total amount of fees paid to insurance company | USD $359 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD D | | Welfare Benefit Premiums Paid to Carrier | USD $10,565 | | 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 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 359 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 5 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $210 | | Total amount of fees paid to insurance company | USD $52 | | Other welfare benefits provided | VOLUNTARY ADD | | Welfare Benefit Premiums Paid to Carrier | USD $1,167 | | 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 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 52 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 6 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $4,406 | | Total amount of fees paid to insurance company | USD $1,125 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1125 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417002415901 |
| Policy instance | 1 |
| Insurance contract or identification number | 417002415901 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $299,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 3 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 4 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,223 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD D | | Welfare Benefit Premiums Paid to Carrier | USD $4,777 | | Commission paid to Insurance Broker | USD $24 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 5 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $137 | | Other welfare benefits provided | VOLUNTARY ADD | | Welfare Benefit Premiums Paid to Carrier | USD $490 | | Commission paid to Insurance Broker | USD $5 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 6 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,587 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,978 | | Commission paid to Insurance Broker | USD $123 | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50047626 |
| Policy instance | 7 |
| Insurance contract or identification number | 50047626 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,961 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,906 | | Commission paid to Insurance Broker | USD $129 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417002415901 |
| Policy instance | 1 |
| Insurance contract or identification number | 417002415901 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Welfare Benefit Premiums Paid to Carrier | USD $145,627 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 3 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 101 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $657 | | Total amount of fees paid to insurance company | USD $481 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $8,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $109 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 481 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 92 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $2,747 | | Total amount of fees paid to insurance company | USD $1,623 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $454 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1623 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 5 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 48 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $3,820 | | Total amount of fees paid to insurance company | USD $1,491 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $25,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $592 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1491 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 6 |
| Insurance contract or identification number | 061297 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-09-30 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 7 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $22,456 | | Total amount of fees paid to insurance company | USD $119,399 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,456 | | Amount paid for insurance broker fees | 119399 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker organization code? | 5 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $5,645 | | Total amount of fees paid to insurance company | USD $7,088 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,645 | | Amount paid for insurance broker fees | 7088 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 3 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 96 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $629 | | Total amount of fees paid to insurance company | USD $575 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $7,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $629 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 575 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 90 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $2,727 | | Total amount of fees paid to insurance company | USD $1,972 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,727 | | Amount paid for insurance broker fees | 1972 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 5 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 41 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $3,432 | | Total amount of fees paid to insurance company | USD $1,571 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $22,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,432 | | Amount paid for insurance broker fees | 1571 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 6 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2021-03-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 100 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $3,312 | | Total amount of fees paid to insurance company | USD $3,837 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,312 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3837 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $23,104 | | Total amount of fees paid to insurance company | USD $117,627 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,104 | | Amount paid for insurance broker fees | 117627 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker organization code? | 5 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $5,767 | | Total amount of fees paid to insurance company | USD $7,290 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,767 | | Amount paid for insurance broker fees | 7290 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 3 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 109 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $771 | | Total amount of fees paid to insurance company | USD $1,117 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $9,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $771 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1117 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 6 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $1,069 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,069 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 5 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 46 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-04-01 | | Total amount of commissions paid to insurance broker | USD $3,940 | | Total amount of fees paid to insurance company | USD $3,127 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $26,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,940 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3127 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 96 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $2,669 | | Total amount of fees paid to insurance company | USD $1,075 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,669 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1075 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 5 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 43 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $3,302 | | Total amount of fees paid to insurance company | USD $1,018 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $22,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,302 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1018 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-30 | | Total amount of fees paid to insurance company | USD $110,115 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 110115 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 5 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-30 | | Total amount of commissions paid to insurance broker | USD $5,421 | | Total amount of fees paid to insurance company | USD $6,499 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6499 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $5,421 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 3 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 101 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-02-01 | | Total amount of commissions paid to insurance broker | USD $621 | | Total amount of fees paid to insurance company | USD $313 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $7,764 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $621 | | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 313 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 6 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,495 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $21,261 | | Total amount of fees paid to insurance company | USD $102,011 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 102011 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $21,261 | | Insurance broker name | ONE DIGITAL |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $1,465 | | Total amount of fees paid to insurance company | USD $6,473 | | Dental Insurance Welfare Benefit | Yes | | Amount paid for insurance broker fees | 6473 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $1,465 | | Insurance broker name | ONE DIGITAL |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 3 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 96 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $2,523 | | Total amount of fees paid to insurance company | USD $1,190 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,226 | | Commission paid to Insurance Broker | USD $1,304 | | Amount paid for insurance broker fees | 424 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | LEGACY CAPITAL GROUP ARKANSAS LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $592 | | Total amount of fees paid to insurance company | USD $356 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $7,395 | | Commission paid to Insurance Broker | USD $288 | | Amount paid for insurance broker fees | 229 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DIGITAL INSURANCE INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANUI |
| Policy instance | 5 |
| Insurance contract or identification number | G000ANUI | | Number of Individuals Covered | 47 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-02-01 | | Total amount of commissions paid to insurance broker | USD $3,571 | | Total amount of fees paid to insurance company | USD $1,037 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $23,807 | | Commission paid to Insurance Broker | USD $1,749 | | Amount paid for insurance broker fees | 719 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | DIIGITAL INSURANCE INC |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 061297 |
| Policy instance | 6 |
| Insurance contract or identification number | 061297 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,012 |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $1,403 | | Total amount of fees paid to insurance company | USD $7,719 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,403 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7719 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $18,318 | | Total amount of fees paid to insurance company | USD $93,934 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,318 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 93934 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ANUI |
| Policy instance | 1 |
| Insurance contract or identification number | GUC0ANUI | | Number of Individuals Covered | 86 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-02-01 | | Total amount of commissions paid to insurance broker | USD $2,072 | | Total amount of fees paid to insurance company | USD $508 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $16,026 | | Total amount of fees paid to insurance company | USD $82,180 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,026 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 82180 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $1,140 | | Total amount of fees paid to insurance company | USD $7,521 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,140 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7521 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE OR OTHER FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 027300 |
| Policy instance | 2 |
| Insurance contract or identification number | 027300 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,414 | | Total amount of fees paid to insurance company | USD $7,776 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,414 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7776 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE COSTS OR FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 ) |
| Policy contract number | 022945 |
| Policy instance | 1 |
| Insurance contract or identification number | 022945 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $15,750 | | Total amount of fees paid to insurance company | USD $72,830 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,750 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 72830 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | | Insurance broker name | ARKANSAS BLUE CROSS AND BLUE SHIELD |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0ANUI |
| Policy instance | 2 |
| Insurance contract or identification number | GUC0ANUI | | Number of Individuals Covered | 92 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-02-01 | | Total amount of commissions paid to insurance broker | USD $2,307 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,067 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 500000045 |
| Policy instance | 1 |
| Insurance contract or identification number | 500000045 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $145 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 500000045 |
| Policy instance | 1 |
| Insurance contract or identification number | 500000045 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $679 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $205 | | Insurance broker organization code? | 3 | | Insurance broker name | LEGACY CAPITAL GROUP OF ARKANSAS |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 500000045 |
| Policy instance | 1 |
| Insurance contract or identification number | 500000045 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $847 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 500000045 |
| Policy instance | 1 |
| Insurance contract or identification number | 500000045 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $1,664 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
