401k Plan data: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN plan

PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN
Plan identification number	501

PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

PELICAN WASTE AND DEBRIS LLC has sponsored the creation of one or more 401k plans.

Company Name: PELICAN WASTE AND DEBRIS LLC

Employer identification number (EIN): 463722840

NAIC Classification: 562000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 RODDIE MATHERNE 2024-07-29
501 2022-01-01 RODDIE MATHERNE 2023-07-20
501 2021-01-01 RODDIE MATHERNE 2022-07-29
501 2020-01-01 RODDIE MATHERNE
501 2019-01-01 RODDIE MATHERNE 2020-06-30
501 2018-01-01 RODDIE MATHERNE 2019-07-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	RODDIE MATHERNE	2024-07-29
501	2022-01-01	RODDIE MATHERNE	2023-07-20
501	2021-01-01	RODDIE MATHERNE	2022-07-29
501	2020-01-01	RODDIE MATHERNE
501	2019-01-01	RODDIE MATHERNE	2020-06-30
501	2018-01-01	RODDIE MATHERNE	2019-07-24

Plan Statistics for PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN

Measure Date Value
2023: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 174
Total of all active and inactive participants 2023-01-01 174
2022: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 202
Total of all active and inactive participants 2022-01-01 202
2021: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 259
Total of all active and inactive participants 2021-01-01 259
2020: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 242
Total of all active and inactive participants 2020-01-01 242
2019: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 281
Total of all active and inactive participants 2019-01-01 281
2018: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 174
Total of all active and inactive participants 2018-01-01 174

Measure	Date	Value
2023: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	174
Total of all active and inactive participants	2023-01-01	174
2022: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	202
Total of all active and inactive participants	2022-01-01	202
2021: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	259
Total of all active and inactive participants	2021-01-01	259
2020: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	242
Total of all active and inactive participants	2020-01-01	242
2019: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	281
Total of all active and inactive participants	2019-01-01	281
2018: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	174
Total of all active and inactive participants	2018-01-01	174

Form 5500 Responses for PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN

2023: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT 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: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT 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: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT 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: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT 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: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT 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: PELICAN WASTE AND DEBRIS LLC GROUP EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

ER00046459

Policy instance

Insurance contract or identification number	ER00046459
Number of Individuals Covered	39
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $41,787
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL ACC,CRITICAL ILLNESS, HOSP STAY
Welfare Benefit Premiums Paid to Carrier	USD $59,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

611-25-S4701

Policy instance

Insurance contract or identification number	611-25-S4701
Number of Individuals Covered	174
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $7,944
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-047722

Policy instance

Insurance contract or identification number	010-047722
Number of Individuals Covered	169
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $3,828
Total amount of fees paid to insurance company	USD $439
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	32
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $11,469
Total amount of fees paid to insurance company	USD $9,147
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	100
Insurance policy start date	2023-04-01
Insurance policy end date	2024-04-01
Total amount of commissions paid to insurance broker	USD $23,753
Total amount of fees paid to insurance company	USD $14,430
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	114
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $25,292
Total amount of fees paid to insurance company	USD $12,784
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 $25,292
Amount paid for insurance broker fees	12784
Additional information about fees paid to insurance broker	INDIRECT COMMISSIONS
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	45
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $11,352
Total amount of fees paid to insurance company	USD $2,129
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $56,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,352
Amount paid for insurance broker fees	2129
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-047722

Policy instance

Insurance contract or identification number	010-047722
Number of Individuals Covered	202
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $5,582
Total amount of fees paid to insurance company	USD $1,459
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,582
Insurance broker organization code?	3
Amount paid for insurance broker fees	1459
Additional information about fees paid to insurance broker	INDIRECT COMMISSIONS

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	48
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $9,750
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL STAY PAY
Welfare Benefit Premiums Paid to Carrier	USD $26,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,825
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	30
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $12,605
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,823
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

891159G

Policy instance

Insurance contract or identification number	891159G
Number of Individuals Covered	54
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,097
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOL ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,053

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

891159G

Policy instance

Insurance contract or identification number	891159G
Number of Individuals Covered	16
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $18,400
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOL ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,248

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	25
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,374
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,862
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	32
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $4,631
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL STAY PAY
Welfare Benefit Premiums Paid to Carrier	USD $13,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,242
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-047722

Policy instance

Insurance contract or identification number	010-047722
Number of Individuals Covered	209
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $6,693
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,049
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	66
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $12,105
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $68,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,105
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	111
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $25,201
Total amount of fees paid to insurance company	USD $12,614
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $720,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,201
Amount paid for insurance broker fees	12614
Additional information about fees paid to insurance broker	INDIRECT COMMISSIONS
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

891159G

Policy instance

Insurance contract or identification number	891159G
Number of Individuals Covered	16
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $18,400
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOL ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,248

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	105
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $23,193
Total amount of fees paid to insurance company	USD $7,073
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $670,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,193
Amount paid for insurance broker fees	7073
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	185
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $27,869
Total amount of fees paid to insurance company	USD $6,178
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $117,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,869
Amount paid for insurance broker fees	6178
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-047722

Policy instance

Insurance contract or identification number	010-047722
Number of Individuals Covered	242
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $7,888
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,718
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	32
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $6,182
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL STAY PAY
Welfare Benefit Premiums Paid to Carrier	USD $13,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,327
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0524700000

Policy instance

Insurance contract or identification number	0524700000
Number of Individuals Covered	42
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $17,502
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,251
Insurance broker organization code?	3

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	268
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $28,765
Total amount of fees paid to insurance company	USD $3,875
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $108,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,765
Amount paid for insurance broker fees	3875
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-047722

Policy instance

Insurance contract or identification number	010-047722
Number of Individuals Covered	281
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $5,056
Total amount of fees paid to insurance company	USD $493
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,056
Amount paid for insurance broker fees	493
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 827037

Policy instance

Insurance contract or identification number	VAI 827037
Number of Individuals Covered	15
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $1,719
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $737
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 801836

Policy instance

Insurance contract or identification number	VCI 801836
Number of Individuals Covered	15
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $2,720
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,166
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	115
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $20,746
Total amount of fees paid to insurance company	USD $7,787
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $592,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,746
Amount paid for insurance broker fees	7787
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

878225G

Policy instance

Insurance contract or identification number	878225G
Number of Individuals Covered	117
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $9,428
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,428
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

29J90ERC

Policy instance

Insurance contract or identification number	29J90ERC
Number of Individuals Covered	106
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Total amount of commissions paid to insurance broker	USD $11,801
Total amount of fees paid to insurance company	USD $2,334
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $327,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,895
Amount paid for insurance broker fees	2334
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

D4450

Policy instance

Insurance contract or identification number	D4450
Number of Individuals Covered	73
Insurance policy start date	2018-01-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $700
Total amount of fees paid to insurance company	USD $840
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $700
Insurance broker organization code?	3
Amount paid for insurance broker fees	455
Additional information about fees paid to insurance broker	ADMIN FEES

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9671215

Policy instance

Insurance contract or identification number	9671215
Number of Individuals Covered	63
Insurance policy start date	2018-01-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $165
Total amount of fees paid to insurance company	USD $166
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $165
Insurance broker organization code?	3
Amount paid for insurance broker fees	83
Additional information about fees paid to insurance broker	ADMIN FEES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-017733-00

Policy instance

Insurance contract or identification number	01-017733-00
Number of Individuals Covered	174
Insurance policy start date	2018-04-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,312
Total amount of fees paid to insurance company	USD $1,639
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $53,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,312
Amount paid for insurance broker fees	1639
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3

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Company Name:	PELICAN WASTE AND DEBRIS LLC
Employer identification number (EIN):	463722840
NAIC Classification:	562000