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GRAYHAWK HOME CARE 401(K) PLAN 401k Plan overview

Plan NameGRAYHAWK HOME CARE 401(K) PLAN
Plan identification number 001

GRAYHAWK HOME CARE 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GRAYHAWK HOME CARE has sponsored the creation of one or more 401k plans.

Company Name:GRAYHAWK HOME CARE
Employer identification number (EIN):471115290
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAYHAWK HOME CARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ANDREW HENDERSON II2023-04-12
0012021-01-01CECILEE YOUNG2022-10-17
0012020-01-01CECILEE YOUNG2021-09-27

Plan Statistics for GRAYHAWK HOME CARE 401(K) PLAN

401k plan membership statisitcs for GRAYHAWK HOME CARE 401(K) PLAN

Measure Date Value
2022: GRAYHAWK HOME CARE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01555
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-010
Number of participants with account balances2022-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: GRAYHAWK HOME CARE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01424
Total number of active participants reported on line 7a of the Form 55002021-01-01534
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-012
Total of all active and inactive participants2021-01-01536
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01536
Number of participants with account balances2021-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: GRAYHAWK HOME CARE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01251
Total number of active participants reported on line 7a of the Form 55002020-01-01386
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-013
Total of all active and inactive participants2020-01-01389
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01389
Number of participants with account balances2020-01-0116

Financial Data on GRAYHAWK HOME CARE 401(K) PLAN

Measure Date Value
2022 : GRAYHAWK HOME CARE 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$1,784
Total income from all sources (including contributions)2022-06-30$-345
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$151,995
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$140,422
Expenses. Certain deemed distributions of participant loans2022-06-30$6,799
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$22,988
Value of total assets at end of year2022-06-30$0
Value of total assets at beginning of year2022-06-30$154,124
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$4,774
Total interest from all sources2022-06-30$52
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2022-06-30$0
Was this plan covered by a fidelity bond2022-06-30No
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$18,586
Participant contributions at end of year2022-06-30$0
Participant contributions at beginning of year2022-06-30$3,932
Participant contributions at end of year2022-06-30$0
Participant contributions at beginning of year2022-06-30$1,762
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-06-30$1,784
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-152,340
Value of net assets at end of year (total assets less liabilities)2022-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$152,340
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Investment advisory and management fees2022-06-30$4,774
Value of interest in pooled separate accounts at end of year2022-06-30$0
Value of interest in pooled separate accounts at beginning of year2022-06-30$134,810
Interest on participant loans2022-06-30$52
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-06-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-06-30$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-06-30$-23,385
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$4,402
Employer contributions (assets) at end of year2022-06-30$0
Employer contributions (assets) at beginning of year2022-06-30$13,620
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$140,422
Did the plan have assets held for investment2022-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30Yes
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30BELFINT, LYONS & SHUMAN, P.A.
Accountancy firm EIN2022-06-30510232399
2021 : GRAYHAWK HOME CARE 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,784
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$104,684
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$16,679
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$10,604
Expenses. Certain deemed distributions of participant loans2021-12-31$2,163
Value of total corrective distributions2021-12-31$425
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$90,908
Value of total assets at end of year2021-12-31$154,124
Value of total assets at beginning of year2021-12-31$64,335
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$3,487
Total interest from all sources2021-12-31$134
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$3,487
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$76,862
Participant contributions at end of year2021-12-31$3,932
Participant contributions at beginning of year2021-12-31$0
Participant contributions at end of year2021-12-31$1,762
Participant contributions at beginning of year2021-12-31$1,542
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$1,784
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$88,005
Value of net assets at end of year (total assets less liabilities)2021-12-31$152,340
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$64,335
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in pooled separate accounts at end of year2021-12-31$134,810
Value of interest in pooled separate accounts at beginning of year2021-12-31$59,093
Interest on participant loans2021-12-31$134
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$13,642
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$14,046
Employer contributions (assets) at end of year2021-12-31$13,620
Employer contributions (assets) at beginning of year2021-12-31$3,700
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$10,604
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BELFINT, LYONS & SHUMAN, P.A.
Accountancy firm EIN2021-12-31510232399
2020 : GRAYHAWK HOME CARE 401(K) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$64,507
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$172
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$0
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$58,977
Value of total assets at end of year2020-12-31$64,335
Value of total assets at beginning of year2020-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$172
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31No
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$20,974
Participant contributions at end of year2020-12-31$1,542
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$34,303
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$64,335
Value of net assets at end of year (total assets less liabilities)2020-12-31$64,335
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$59,093
Value of interest in pooled separate accounts at beginning of year2020-12-31$0
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$0
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$0
Net investment gain/loss from pooled separate accounts2020-12-31$5,530
Net investment gain or loss from common/collective trusts2020-12-31$0
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$3,700
Employer contributions (assets) at end of year2020-12-31$3,700
Employer contributions (assets) at beginning of year2020-12-31$0
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$0
Contract administrator fees2020-12-31$172
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31BELFINT, LYONS & SHUMAN, P.A.
Accountancy firm EIN2020-12-31510232399

Form 5500 Responses for GRAYHAWK HOME CARE 401(K) PLAN

2022: GRAYHAWK HOME CARE 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingYes
2022-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: GRAYHAWK HOME CARE 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GRAYHAWK HOME CARE 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number724227
Policy instance 1
Insurance contract or identification number724227
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number724227
Policy instance 1
Insurance contract or identification number724227
Number of Individuals Covered23
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number724227
Policy instance 1
Insurance contract or identification number724227
Number of Individuals Covered421
Insurance policy start date2020-03-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3

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