ROSENBOOM MACHINE & TOOL, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN
401k plan membership statisitcs for ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN
| Measure | Date | Value |
|---|
| 2023: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 284 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 284 |
| 2022: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 129 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 129 |
| 2021: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 140 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 140 |
| 2020: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 150 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 150 |
| 2019: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 187 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 187 |
| 2018: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 197 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 197 |
| 2017: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 157 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 157 |
| 2016: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 151 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 151 |
| 2015: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 158 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 158 |
| 2014: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 207 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 207 |
| 2013: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 173 |
| Total of all active and inactive participants | 2013-01-01 | 173 |
| 2012: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 135 |
| Total of all active and inactive participants | 2012-01-01 | 135 |
| 2011: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 105 |
| Total of all active and inactive participants | 2011-01-01 | 105 |
| 2010: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 181 |
| Total of all active and inactive participants | 2010-01-01 | 181 |
| 2009: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 127 |
| Total of all active and inactive participants | 2009-01-01 | 0 |
| 2023: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ROSENBOOM MACHINE & TOOL, INC. SECTION 125 PREMIUM ONLY PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0175307 |
| Policy instance | 1 |
| Insurance contract or identification number | 0175307 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $8,870 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,878,118 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | L01593 |
| Policy instance | 1 |
| Insurance contract or identification number | L01593 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $81,753 | | Total amount of fees paid to insurance company | USD $2,085 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,833,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,753 | | Amount paid for insurance broker fees | 2085 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker organization code? | 3 |
|
| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | L01593 |
| Policy instance | 1 |
| Insurance contract or identification number | L01593 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $74,141 | | Total amount of fees paid to insurance company | USD $5,917 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,853,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,809 | | Amount paid for insurance broker fees | 5917 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker organization code? | 3 |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 031128 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 031128 & CD0114 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $66,806 | | 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 $66,806 | | Insurance broker organization code? | 3 |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 031128 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 031128 & CD0114 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $68,824 | | 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 $68,824 | | Insurance broker organization code? | 3 |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 031128 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 031128 & CD0114 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $67,499 | | 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 $67,499 | | Insurance broker organization code? | 4 |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 031128 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 031128 & CD0114 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $49,967 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,665,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,967 | | Insurance broker organization code? | 4 | | Insurance broker name | KAMINSKY & ASSOCIATES, INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00508664 |
| Policy instance | 2 |
| Insurance contract or identification number | 00508664 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,591 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,591 | | Insurance broker name | KAMINSKY & ASSOCIATES |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 030299 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 030299 & CD0114 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $52,449 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,748,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,449 | | Insurance broker name | KAMINSKY & ASSOCIATES, INC |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | 503R83 & BP0330 |
| Policy instance | 2 |
| Insurance contract or identification number | 503R83 & BP0330 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,625 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,625 | | Insurance broker name | KAMINSKY & ASSOCIATES |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 030299 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 030299 & CD0114 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $52,707 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,756,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,707 | | Insurance broker name | KAMINSKY & ASSOCIATES, INC |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | 503R83 |
| Policy instance | 2 |
| Insurance contract or identification number | 503R83 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,167 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $89,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,167 | | Insurance broker name | KAMINSKY & ASSOCIATES |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 030299 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 030299 & CD0114 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $39,106 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,303,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,106 | | Insurance broker name | KAMINSKY & ASSOCIATES, INC |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 030299 & CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 030299 & CD0114 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,778 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $892,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,778 | | Insurance broker name | KAMINSKY & ASSOCIATES, INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F1D0765 |
| Policy instance | 2 |
| Insurance contract or identification number | F1D0765 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,167 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,167 | | Insurance broker name | KAMINSKY & ASSOCIATES INC |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 212895 |
| Policy instance | 3 |
| Insurance contract or identification number | 212895 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-04-01 | | Total amount of commissions paid to insurance broker | USD $299 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F1D0765 |
| Policy instance | 2 |
| Insurance contract or identification number | F1D0765 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,488 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | 030299 CD0114 |
| Policy instance | 1 |
| Insurance contract or identification number | 030299 CD0114 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $19,967 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $665,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 181 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of fees paid to insurance company | USD $23,528 | | 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 | 23528 | | Additional information about fees paid to insurance broker | COMMISSIONS FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MICHAEL WONG |
|
