ROTELLAS ITALIAN BAKERY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D
401k plan membership statisitcs for ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D
| Measure | Date | Value |
|---|
| 2022: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 406 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 345 |
| 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 | 345 |
| 2021: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 406 |
| 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 | 406 |
| 2020: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 432 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 422 |
| 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 | 422 |
| 2019: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 438 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 432 |
| Number of retired or separated participants receiving benefits | 2019-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-03-01 | 0 |
| Total of all active and inactive participants | 2019-03-01 | 432 |
| 2018: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 438 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
| Total of all active and inactive participants | 2018-03-01 | 438 |
| 2017: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 420 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
| Total of all active and inactive participants | 2017-03-01 | 420 |
| 2016: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 368 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 420 |
| Number of retired or separated participants receiving benefits | 2016-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
| Total of all active and inactive participants | 2016-03-01 | 420 |
| 2015: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 364 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 368 |
| Number of retired or separated participants receiving benefits | 2015-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
| Total of all active and inactive participants | 2015-03-01 | 368 |
| 2014: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 334 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 364 |
| Number of retired or separated participants receiving benefits | 2014-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-03-01 | 0 |
| Total of all active and inactive participants | 2014-03-01 | 364 |
| 2013: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 302 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 334 |
| Total of all active and inactive participants | 2013-03-01 | 334 |
| 2012: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 302 |
| Total of all active and inactive participants | 2012-03-01 | 302 |
| 2011: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 259 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 290 |
| Total of all active and inactive participants | 2011-03-01 | 290 |
| 2009: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 229 |
| Total of all active and inactive participants | 2009-03-01 | 229 |
| 2022: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 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: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 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: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 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: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2019 form 5500 responses |
|---|
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-03-01 | Plan funding arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Plan funding arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Plan funding arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2009 form 5500 responses |
|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | Plan funding arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2008 form 5500 responses |
|---|
| 2008-03-01 | Type of plan entity | Single employer plan |
| 2008-03-01 | Submission has been amended | Yes |
| 2008-03-01 | This submission is the final filing | No |
| 2008-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-03-01 | Plan is a collectively bargained plan | No |
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L2210022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L2210022000 | | Number of Individuals Covered | 345 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $61,785 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $574,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 61785 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 329 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,478 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,478 | | Insurance broker organization code? | 3 |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L2010022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L2010022000 | | Number of Individuals Covered | 406 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $73,380 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $516,136 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 73380 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 374 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,830 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,830 | | Insurance broker organization code? | 3 |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L2010022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L2010022000 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $75,825 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $440,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 75825 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 417 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,877 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,877 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 422 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,589 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,589 | | Insurance broker organization code? | 3 |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L1810022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L1810022000 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $64,830 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $422,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 64830 | | Insurance broker organization code? | 5 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 448 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $1,866 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,866 | | Insurance broker organization code? | 3 |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L1810022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L1810022000 | | Number of Individuals Covered | 438 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of fees paid to insurance company | USD $78,780 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $495,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 78780 | | Insurance broker organization code? | 5 |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | EMC L1610022000 |
| Policy instance | 2 |
| Insurance contract or identification number | EMC L1610022000 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of fees paid to insurance company | USD $74,595 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $431,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 74595 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 437 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $1,780 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,780 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERL L12100660 |
| Policy instance | 2 |
| Insurance contract or identification number | ERL L12100660 | | Number of Individuals Covered | 368 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of fees paid to insurance company | USD $70,320 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $408,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 70320 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AVZM |
| Policy instance | 1 |
| Insurance contract or identification number | G000AVZM | | Number of Individuals Covered | 404 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $1,664 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $16,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,664 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERL L12100660 |
| Policy instance | 2 |
| Insurance contract or identification number | ERL L12100660 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of fees paid to insurance company | USD $65,460 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $375,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 65460 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149730 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 149730 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $1,450 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,450 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERL L12100660 |
| Policy instance | 2 |
| Insurance contract or identification number | ERL L12100660 | | Number of Individuals Covered | 334 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of fees paid to insurance company | USD $58,485 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $310,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 58485 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149730 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 149730 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $1,340 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,340 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 ) |
| Policy contract number | ERL L12100660 |
| Policy instance | 2 |
| Insurance contract or identification number | ERL L12100660 | | Number of Individuals Covered | 302 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of fees paid to insurance company | USD $52,665 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $254,049 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 52665 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 149730 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 149730 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $1,246 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,246 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10113445 |
| Policy instance | 1 |
| Insurance contract or identification number | 10113445 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $990 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,696 | | 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 number | HCL17649 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL17649 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2011-03-01 | | Insurance policy end date | 2012-02-29 | | Total amount of fees paid to insurance company | USD $51,525 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $241,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10113445 |
| Policy instance | 1 |
| Insurance contract or identification number | 10113445 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $920 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,947 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $920 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED BENEFITS GROUP LLC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL17649 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL17649 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2011-02-28 | | Total amount of fees paid to insurance company | USD $44,970 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $189,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 44970 | | Insurance broker organization code? | 5 | | Insurance broker name | MID-AMERICAN BENEFITS, INC |
|
