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UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan NameUNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN
Plan identification number 510

UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

UNITED CABINET COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name:UNITED CABINET COMPANY, LLC
Employer identification number (EIN):371417152
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102023-04-01ELLEN NAPIER2024-10-21
5102022-04-01ELLEN NAPIER2024-01-16
5102021-04-01JAMES BARDON2022-08-15
5102020-04-01HAROLD PHILBRICK2022-01-24
5102019-04-01HAROLD PHILBRICK2022-01-24
5102018-04-01HAROLD PHILBRICK2022-01-24
5102017-04-01HAROLD PHILBRICK2022-01-24
5102016-04-01SHADE MURRAY
5102015-04-01SHADE MURRAY
5102014-04-01SHADE MURRAY
5102013-04-01SHADE MURRAY
5102012-04-01SHADE MURRAY
5102011-04-01SHADE MURRAY

Plan Statistics for UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN

Measure Date Value
2023: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-04-0189
Total number of active participants reported on line 7a of the Form 55002023-04-0189
Number of retired or separated participants receiving benefits2023-04-010
Number of other retired or separated participants entitled to future benefits2023-04-010
Total of all active and inactive participants2023-04-0189
Number of employers contributing to the scheme2023-04-010
2022: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-0193
Total number of active participants reported on line 7a of the Form 55002022-04-0166
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-0166
Number of employers contributing to the scheme2022-04-010
2021: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01117
Total number of active participants reported on line 7a of the Form 55002021-04-0193
Number of retired or separated participants receiving benefits2021-04-012
Number of other retired or separated participants entitled to future benefits2021-04-018
Total of all active and inactive participants2021-04-01103
Number of employers contributing to the scheme2021-04-010
2020: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01114
Total number of active participants reported on line 7a of the Form 55002020-04-01107
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-0110
Total of all active and inactive participants2020-04-01117
Number of employers contributing to the scheme2020-04-010
2019: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01127
Total number of active participants reported on line 7a of the Form 55002019-04-01110
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01110
Number of employers contributing to the scheme2019-04-010
2018: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01201
Total number of active participants reported on line 7a of the Form 55002018-04-01127
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01127
Number of employers contributing to the scheme2018-04-010
2017: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01201
Total number of active participants reported on line 7a of the Form 55002017-04-01201
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01201
Number of employers contributing to the scheme2017-04-010
2016: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01227
Total number of active participants reported on line 7a of the Form 55002016-04-01201
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01201
2015: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01233
Total number of active participants reported on line 7a of the Form 55002015-04-010
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-010
2014: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01230
Total number of active participants reported on line 7a of the Form 55002014-04-01230
Number of retired or separated participants receiving benefits2014-04-010
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01230
2013: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01177
Total number of active participants reported on line 7a of the Form 55002013-04-01210
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01210
2012: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01168
Total number of active participants reported on line 7a of the Form 55002012-04-01177
Number of retired or separated participants receiving benefits2012-04-010
Number of other retired or separated participants entitled to future benefits2012-04-010
Total of all active and inactive participants2012-04-01177
2011: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01129
Total number of active participants reported on line 7a of the Form 55002011-04-01168
Number of retired or separated participants receiving benefits2011-04-010
Number of other retired or separated participants entitled to future benefits2011-04-010
Total of all active and inactive participants2011-04-01168

Form 5500 Responses for UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN

2023: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan funding arrangement – General assets of the sponsorYes
2023-04-01Plan benefit arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – General assets of the sponsorYes
2022: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: UNITED CABINET COMPANY, LLC UNITED CABINET COMPANY, LLC WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01First time form 5500 has been submittedYes
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0BBZV
Policy instance 5
Insurance contract or identification numberGUDH0BBZV
Number of Individuals Covered15
Insurance policy start date2023-04-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $545
Total amount of fees paid to insurance companyUSD $191
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $3,636
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 numberGUC0BBZV
Policy instance 4
Insurance contract or identification numberGUC0BBZV
Number of Individuals Covered18
Insurance policy start date2023-04-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $1,619
Total amount of fees paid to insurance companyUSD $572
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,792
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 numberGVTL0BBZV
Policy instance 3
Insurance contract or identification numberGVTL0BBZV
Number of Individuals Covered19
Insurance policy start date2023-04-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $2,261
Total amount of fees paid to insurance companyUSD $830
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $15,076
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 numberGLUG0BBZV
Policy instance 2
Insurance contract or identification numberGLUG0BBZV
Number of Individuals Covered70
Insurance policy start date2023-04-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $1,209
Total amount of fees paid to insurance companyUSD $481
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914260
Policy instance 1
Insurance contract or identification number914260
Number of Individuals Covered89
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $2,724
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,244
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 numberGLUG0BBZV
Policy instance 2
Insurance contract or identification numberGLUG0BBZV
Number of Individuals Covered98
Insurance policy start date2022-04-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $398
Total amount of fees paid to insurance companyUSD $495
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $2,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $398
Amount paid for insurance broker fees362
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914260
Policy instance 1
Insurance contract or identification number914260
Number of Individuals Covered126
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $3,620
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,620
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBZV
Policy instance 2
Insurance contract or identification numberGLUG0BBZV
Number of Individuals Covered93
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $6,179
Total amount of fees paid to insurance companyUSD $2,176
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $41,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,116
Amount paid for insurance broker fees2176
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914260
Policy instance 1
Insurance contract or identification number914260
Number of Individuals Covered144
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $2,213
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,653
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBZV
Policy instance 2
Insurance contract or identification numberGLUG0BBZV
Number of Individuals Covered108
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $4,720
Total amount of fees paid to insurance companyUSD $1,984
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $31,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,720
Amount paid for insurance broker fees1984
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914260
Policy instance 1
Insurance contract or identification number914260
Number of Individuals Covered131
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $2,967
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,967
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BBZV
Policy instance 2
Insurance contract or identification numberGLUG0BBZV
Number of Individuals Covered127
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $5,037
Total amount of fees paid to insurance companyUSD $3,508
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $33,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,037
Amount paid for insurance broker fees2619
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914260
Policy instance 1
Insurance contract or identification number914260
Number of Individuals Covered157
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $3,934
Total amount of fees paid to insurance companyUSD $32,470
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $699,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,934
Amount paid for insurance broker fees32470
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10145256
Policy instance 2
Insurance contract or identification number10145256
Number of Individuals Covered201
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number83693
Policy instance 1
Insurance contract or identification number83693
Number of Individuals Covered176
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $29,329
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $700,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,330
Amount paid for insurance broker fees0
Insurance broker organization code?3

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