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SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 401k Plan overview

Plan NameSMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN
Plan identification number 501

SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SMITH SYSTEM MANUFACTURING COMPANY has sponsored the creation of one or more 401k plans.

Company Name:SMITH SYSTEM MANUFACTURING COMPANY
Employer identification number (EIN):411424908
NAIC Classification:337000

Additional information about SMITH SYSTEM MANUFACTURING COMPANY

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 0932124

More information about SMITH SYSTEM MANUFACTURING COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01
5012021-06-01
5012020-06-01
5012019-06-01
5012018-06-01
5012017-06-01WILLIAM SCHAAD WILLIAM SCHAAD2018-12-17
5012017-01-01BILL SCHAAD BILL SCHAAD2018-03-26
5012016-06-01WILLIAM SCHAAD WILLIAM SCHAAD2018-03-08
5012015-06-01WILLIAM SCHAAD WILLIAM SCHAAD2017-03-14
5012014-06-01WILLIAM SCHAAD WILLIAM SCHAAD2016-03-15
5012013-06-01WILLIAM SCHAAD WILLIAM SCHAAD2015-01-05
5012012-06-01WILLIAM SCHAAD WILLIAM SCHAAD2014-03-13
5012011-06-01WILLIAM SCHAAD
5012010-06-01WILLIAM SCHAAD
5012009-06-01 WILLIAM SCHAAD2010-12-08
5012009-06-01WILLIAM SCHAAD

Plan Statistics for SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN

401k plan membership statisitcs for SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN

Measure Date Value
2022: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01166
Total number of active participants reported on line 7a of the Form 55002022-06-01173
Number of retired or separated participants receiving benefits2022-06-011
Number of other retired or separated participants entitled to future benefits2022-06-011
Total of all active and inactive participants2022-06-01175
2021: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01172
Total number of active participants reported on line 7a of the Form 55002021-06-01189
Number of retired or separated participants receiving benefits2021-06-011
Number of other retired or separated participants entitled to future benefits2021-06-011
Total of all active and inactive participants2021-06-01191
2020: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01157
Total number of active participants reported on line 7a of the Form 55002020-06-01155
Number of retired or separated participants receiving benefits2020-06-010
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-01155
2019: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01147
Total number of active participants reported on line 7a of the Form 55002019-06-01137
Number of retired or separated participants receiving benefits2019-06-010
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01137
2018: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01117
Total number of active participants reported on line 7a of the Form 55002018-06-01158
Total of all active and inactive participants2018-06-01158
Total participants2018-06-01158
2017: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-0195
Total number of active participants reported on line 7a of the Form 55002017-06-01117
Total of all active and inactive participants2017-06-01117
Total participants2017-06-01117
Total participants, beginning-of-year2017-01-01113
Total number of active participants reported on line 7a of the Form 55002017-01-01126
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Number of participants with account balances2017-01-010
2016: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-0195
Total of all active and inactive participants2016-06-010
Total participants2016-06-010
2015: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01126
Total number of active participants reported on line 7a of the Form 55002015-06-0195
Total of all active and inactive participants2015-06-0195
Total participants2015-06-0195
2014: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01129
Total number of active participants reported on line 7a of the Form 55002014-06-01126
Total of all active and inactive participants2014-06-01126
Total participants2014-06-01126
2013: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01131
Total number of active participants reported on line 7a of the Form 55002013-06-01129
Total of all active and inactive participants2013-06-01129
Total participants2013-06-01129
2012: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01135
Total number of active participants reported on line 7a of the Form 55002012-06-01131
Total of all active and inactive participants2012-06-01131
Total participants2012-06-01131
2011: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01108
Total number of active participants reported on line 7a of the Form 55002011-06-01135
Total of all active and inactive participants2011-06-01135
Total participants2011-06-01135
2010: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01117
Total number of active participants reported on line 7a of the Form 55002010-06-01108
Total of all active and inactive participants2010-06-01108
Total participants2010-06-01108
2009: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-0199
Total number of active participants reported on line 7a of the Form 55002009-06-01117
Total of all active and inactive participants2009-06-01117
Total participants2009-06-01117

Financial Data on SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN

Measure Date Value
2019 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2019 401k financial data
Total income from all sources2019-05-31$729,782
Expenses. Total of all expenses incurred2019-05-31$729,782
Benefits paid (including direct rollovers)2019-05-31$525,227
Expenses. Other expenses not covered elsewhere2019-05-31$204,555
Net income (gross income less expenses)2019-05-31$0
Total contributions received or receivable from employer(s)2019-05-31$729,782
2018 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2018 401k financial data
Total income from all sources2018-05-31$740,158
Expenses. Total of all expenses incurred2018-05-31$740,158
Benefits paid (including direct rollovers)2018-05-31$542,407
Expenses. Other expenses not covered elsewhere2018-05-31$197,751
Net income (gross income less expenses)2018-05-31$0
Total contributions received or receivable from employer(s)2018-05-31$740,158
2017 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-05-31$0
Total plan liabilities at beginning of year2017-05-31$0
Total income from all sources2017-05-31$976,271
Expenses. Total of all expenses incurred2017-05-31$976,271
Benefits paid (including direct rollovers)2017-05-31$767,092
Total plan assets at end of year2017-05-31$0
Total plan assets at beginning of year2017-05-31$0
Expenses. Other expenses not covered elsewhere2017-05-31$209,179
Net income (gross income less expenses)2017-05-31$0
Net plan assets at end of year (total assets less liabilities)2017-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$0
Total contributions received or receivable from employer(s)2017-05-31$976,271
2016 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-05-31$0
Total plan liabilities at beginning of year2016-05-31$0
Total income from all sources2016-05-31$1,118,571
Expenses. Total of all expenses incurred2016-05-31$1,118,571
Benefits paid (including direct rollovers)2016-05-31$936,204
Total plan assets at end of year2016-05-31$0
Total plan assets at beginning of year2016-05-31$0
Expenses. Other expenses not covered elsewhere2016-05-31$182,367
Net income (gross income less expenses)2016-05-31$0
Net plan assets at end of year (total assets less liabilities)2016-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$0
Total contributions received or receivable from employer(s)2016-05-31$1,118,571
2015 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2015 401k financial data
Total plan liabilities at end of year2015-05-31$0
Total plan liabilities at beginning of year2015-05-31$0
Total income from all sources2015-05-31$753,363
Expenses. Total of all expenses incurred2015-05-31$753,363
Benefits paid (including direct rollovers)2015-05-31$615,567
Total plan assets at end of year2015-05-31$0
Total plan assets at beginning of year2015-05-31$0
Expenses. Other expenses not covered elsewhere2015-05-31$137,796
Net income (gross income less expenses)2015-05-31$0
Net plan assets at end of year (total assets less liabilities)2015-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-05-31$0
Total contributions received or receivable from employer(s)2015-05-31$753,363
2014 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-05-31$152
Total income from all sources2014-05-31$733,508
Expenses. Total of all expenses incurred2014-05-31$733,356
Benefits paid (including direct rollovers)2014-05-31$605,136
Expenses. Other expenses not covered elsewhere2014-05-31$128,220
Net income (gross income less expenses)2014-05-31$152
Net plan assets at end of year (total assets less liabilities)2014-05-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-05-31$-152
Total contributions received or receivable from employer(s)2014-05-31$733,508
2013 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2013 401k financial data
Total plan liabilities at end of year2013-05-31$152
Total plan liabilities at beginning of year2013-05-31$152
Total income from all sources2013-05-31$706,494
Expenses. Total of all expenses incurred2013-05-31$706,494
Benefits paid (including direct rollovers)2013-05-31$565,757
Total plan assets at end of year2013-05-31$0
Total plan assets at beginning of year2013-05-31$0
Expenses. Other expenses not covered elsewhere2013-05-31$140,737
Net income (gross income less expenses)2013-05-31$0
Net plan assets at end of year (total assets less liabilities)2013-05-31$-152
Net plan assets at beginning of year (total assets less liabilities)2013-05-31$-152
Total contributions received or receivable from employer(s)2013-05-31$706,494
2012 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2012 401k financial data
Total plan liabilities at end of year2012-05-31$152
Total plan liabilities at beginning of year2012-05-31$152
Total income from all sources2012-05-31$486,556
Expenses. Total of all expenses incurred2012-05-31$486,556
Benefits paid (including direct rollovers)2012-05-31$363,312
Total plan assets at end of year2012-05-31$0
Total plan assets at beginning of year2012-05-31$0
Expenses. Other expenses not covered elsewhere2012-05-31$123,244
Net income (gross income less expenses)2012-05-31$0
Net plan assets at end of year (total assets less liabilities)2012-05-31$-152
Net plan assets at beginning of year (total assets less liabilities)2012-05-31$-152
Total contributions received or receivable from employer(s)2012-05-31$486,556
2011 : SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2011 401k financial data
Total plan liabilities at end of year2011-05-31$152
Total income from all sources2011-05-31$436,633
Expenses. Total of all expenses incurred2011-05-31$439,114
Benefits paid (including direct rollovers)2011-05-31$329,781
Total plan assets at end of year2011-05-31$0
Total plan assets at beginning of year2011-05-31$2,329
Expenses. Other expenses not covered elsewhere2011-05-31$109,333
Net income (gross income less expenses)2011-05-31$-2,481
Net plan assets at end of year (total assets less liabilities)2011-05-31$-152
Net plan assets at beginning of year (total assets less liabilities)2011-05-31$2,329
Total contributions received or receivable from employer(s)2011-05-31$436,633

Form 5500 Responses for SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN

2022: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan funding arrangement – General assets of the sponsorYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – General assets of the sponsorYes
2021: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – General assets of the sponsorYes
2013: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – General assets of the sponsorYes
2012: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – General assets of the sponsorYes
2011: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – General assets of the sponsorYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – General assets of the sponsorYes
2010: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – General assets of the sponsorYes
2009: SMITH SYSTEM MANUFACTURING COMPANY HEALTH PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01First time form 5500 has been submittedYes
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – General assets of the sponsorYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000513
Policy instance 2
Insurance contract or identification number1000513
Number of Individuals Covered199
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,139
Other welfare benefits providedMANAGED ORGAN/TISSUE TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $11,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,139
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered169
Insurance policy start date2022-03-01
Insurance policy end date2023-02-28
Total amount of commissions paid to insurance brokerUSD $16,020
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $78,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,020
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered157
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $16,121
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $71,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,121
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000513
Policy instance 2
Insurance contract or identification number1000513
Number of Individuals Covered183
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,175
Other welfare benefits providedMANAGED ORGAN/TISSUE TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $11,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,175
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000513
Policy instance 2
Insurance contract or identification number1000513
Number of Individuals Covered186
Insurance policy start date2020-06-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $695
Other welfare benefits providedMANAGED ORGAN/TISSUE TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $6,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $695
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered159
Insurance policy start date2020-07-01
Insurance policy end date2021-02-28
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $47,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance broker10581
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered158
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $14,134
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $63,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,134
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number4014
Policy instance 1
Insurance contract or identification number4014
Number of Individuals Covered68
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $21,359
Total amount of fees paid to insurance companyUSD $6,326
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $147,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,359
Amount paid for insurance broker fees6326
Additional information about fees paid to insurance brokerBROKER FEE
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 2
Insurance contract or identification number0102366
Number of Individuals Covered147
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $12,264
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $56,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,264
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number14
Policy instance 1
Insurance contract or identification number14
Number of Individuals Covered57
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $23,874
Total amount of fees paid to insurance companyUSD $6,158
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $134,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,874
Amount paid for insurance broker fees6158
Additional information about fees paid to insurance brokerBROKER FEE
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 2
Insurance contract or identification number0102366
Number of Individuals Covered117
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $10,465
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $43,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,465
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366 METLIFE
Policy instance 2
Insurance contract or identification number0102366 METLIFE
Number of Individuals Covered95
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $7,508
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $31,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,508
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
QBE INSURANCE (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract numberQBE
Policy instance 1
Insurance contract or identification numberQBE
Number of Individuals Covered79
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $23,626
Total amount of fees paid to insurance companyUSD $4,974
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $124,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,626
Amount paid for insurance broker fees2974
Additional information about fees paid to insurance brokerBROKER FEE
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 2
Insurance contract or identification number0102366
Number of Individuals Covered84
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $5,653
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $27,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,653
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
QBE INSURANCE (National Association of Insurance Commissioners NAIC id number: 10219 )
Policy contract number14
Policy instance 1
Insurance contract or identification number14
Number of Individuals Covered47
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $22,405
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $92,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,431
Amount paid for insurance broker fees4974
Additional information about fees paid to insurance brokerBROKER FEE
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number102366
Policy instance 1
Insurance contract or identification number102366
Number of Individuals Covered85
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,060
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $29,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,060
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number14
Policy instance 2
Insurance contract or identification number14
Number of Individuals Covered44
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $16,262
Total amount of fees paid to insurance companyUSD $4,974
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $85,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,262
Amount paid for insurance broker fees4974
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered88
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $7,446
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
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 CarrierUSD $29,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,446
Insurance broker organization code?3
Insurance broker nameSCOT MOORES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number14
Policy instance 2
Insurance contract or identification number14
Number of Individuals Covered47
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $18,531
Total amount of fees paid to insurance companyUSD $5,347
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $93,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,531
Amount paid for insurance broker fees5347
Additional information about fees paid to insurance brokerBROKER FEE
Insurance broker nameSCOT MOORES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 1
Insurance contract or identification number0102366
Number of Individuals Covered135
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $6,381
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,377
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 number14
Policy instance 2
Insurance contract or identification number14
Number of Individuals Covered45
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $14,443
Total amount of fees paid to insurance companyUSD $4,974
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0102366
Policy instance 2
Insurance contract or identification number0102366
Number of Individuals Covered108
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $7,002
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,203
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 number14
Policy instance 1
Insurance contract or identification number14
Number of Individuals Covered30
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $15,538
Total amount of fees paid to insurance companyUSD $4,974
Health Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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