401k Plan data: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN plan

PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN
Plan identification number	502

PENNY'S CONCRETE, INC. HEALTH INSURANCE 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)

401k Sponsoring company profile

PENNY'S CONCRETE, INC has sponsored the creation of one or more 401k plans.

Company Name: PENNY'S CONCRETE, INC

Employer identification number (EIN): 480863404

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01
502 2017-01-01 YVONNE G. BROWNELL
502 2016-01-01 YVONNE G. BROWNELL
502 2015-01-01 YVONNE G. BROWNELL
502 2014-01-01 YVONNE G. BROWNELL
502 2013-01-01 YVONNE G. BROWNELL
502 2012-11-01 ALAN W. GROESBECK
502 2011-11-01 ALAN W GROESBECK
502 2010-11-01 ALAN W GROESBECK
502 2009-11-01 ALAN GROESBECK

Plan Statistics for PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN

401k plan membership statisitcs for PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN

Measure Date Value
2022: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 338
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 305
Total of all active and inactive participants 2022-01-01 305
Total participants 2022-01-01 305
2021: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 324
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 338
Total of all active and inactive participants 2021-01-01 338
Total participants 2021-01-01 338
2020: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 356
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 324
Total of all active and inactive participants 2020-01-01 324
Total participants 2020-01-01 324
2019: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 300
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 356
Total of all active and inactive participants 2019-01-01 356
Total participants 2019-01-01 356
2018: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 304
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 300
Total of all active and inactive participants 2018-01-01 300
Total participants 2018-01-01 300
2017: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 305
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 304
Total of all active and inactive participants 2017-01-01 304
Total participants 2017-01-01 304
2016: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 429
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 327
Total of all active and inactive participants 2016-01-01 327
Total participants 2016-01-01 327
2015: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 426
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 429
Total of all active and inactive participants 2015-01-01 429
Total participants 2015-01-01 0
2014: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 434
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 426
Total of all active and inactive participants 2014-01-01 426
Total participants 2014-01-01 0
2013: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 440
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 434
Total of all active and inactive participants 2013-01-01 434
Total participants 2013-01-01 0
2012: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-11-01 444
Total number of active participants reported on line 7a of the Form 5500 2012-11-01 440
Total of all active and inactive participants 2012-11-01 440
Total participants 2012-11-01 0
2011: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-11-01 383
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 444
Total of all active and inactive participants 2011-11-01 444
Total participants 2011-11-01 444
2010: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-11-01 364
Total number of active participants reported on line 7a of the Form 5500 2010-11-01 383
Total of all active and inactive participants 2010-11-01 383
Total participants 2010-11-01 383
2009: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-11-01 402
Total number of active participants reported on line 7a of the Form 5500 2009-11-01 364
Total of all active and inactive participants 2009-11-01 364
Total participants 2009-11-01 364

Measure	Date	Value
2022: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	338
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	305
Total of all active and inactive participants	2022-01-01	305
Total participants	2022-01-01	305
2021: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	324
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	338
Total of all active and inactive participants	2021-01-01	338
Total participants	2021-01-01	338
2020: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	356
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	324
Total of all active and inactive participants	2020-01-01	324
Total participants	2020-01-01	324
2019: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	300
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	356
Total of all active and inactive participants	2019-01-01	356
Total participants	2019-01-01	356
2018: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	304
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	300
Total of all active and inactive participants	2018-01-01	300
Total participants	2018-01-01	300
2017: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	304
Total of all active and inactive participants	2017-01-01	304
Total participants	2017-01-01	304
2016: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	429
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	327
Total of all active and inactive participants	2016-01-01	327
Total participants	2016-01-01	327
2015: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	426
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	429
Total of all active and inactive participants	2015-01-01	429
Total participants	2015-01-01	0
2014: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	434
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	426
Total of all active and inactive participants	2014-01-01	426
Total participants	2014-01-01	0
2013: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	440
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	434
Total of all active and inactive participants	2013-01-01	434
Total participants	2013-01-01	0
2012: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-11-01	444
Total number of active participants reported on line 7a of the Form 5500	2012-11-01	440
Total of all active and inactive participants	2012-11-01	440
Total participants	2012-11-01	0
2011: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-11-01	383
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	444
Total of all active and inactive participants	2011-11-01	444
Total participants	2011-11-01	444
2010: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-11-01	364
Total number of active participants reported on line 7a of the Form 5500	2010-11-01	383
Total of all active and inactive participants	2010-11-01	383
Total participants	2010-11-01	383
2009: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-11-01	402
Total number of active participants reported on line 7a of the Form 5500	2009-11-01	364
Total of all active and inactive participants	2009-11-01	364
Total participants	2009-11-01	364

Form 5500 Responses for PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN

2022: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE 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: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-11-01	Type of plan entity	Single employer plan
2012-11-01	Submission has been amended	Yes
2012-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-11-01	Plan funding arrangement – Insurance	Yes
2012-11-01	Plan benefit arrangement – Insurance	Yes
2011: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes
2010: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2010 form 5500 responses
2010-11-01	Type of plan entity	Single employer plan
2010-11-01	Plan funding arrangement – Insurance	Yes
2010-11-01	Plan benefit arrangement – Insurance	Yes
2009: PENNY'S CONCRETE, INC. HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-11-01	Type of plan entity	Single employer plan
2009-11-01	Plan funding arrangement – Insurance	Yes
2009-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0916280

Policy instance

Insurance contract or identification number	0916280
Number of Individuals Covered	305
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,096
Total amount of fees paid to insurance company	USD $41,983
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,498,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,096
Amount paid for insurance broker fees	41983
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	106
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $24,880
Total amount of fees paid to insurance company	USD $509
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,724
Amount paid for insurance broker fees	310
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0916280

Policy instance

Insurance contract or identification number	0916280
Number of Individuals Covered	338
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $47,409
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,391,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,409
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	104
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $21,585
Total amount of fees paid to insurance company	USD $844
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,631
Amount paid for insurance broker fees	21
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	119
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,996
Total amount of fees paid to insurance company	USD $414
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,462
Amount paid for insurance broker fees	280
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0916280

Policy instance

Insurance contract or identification number	0916280
Number of Individuals Covered	324
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $45,558
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,443,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,558
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

307241

Policy instance

Insurance contract or identification number	307241
Number of Individuals Covered	156
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,483
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $43,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,483
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	114
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $18,247
Total amount of fees paid to insurance company	USD $826
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,465
Amount paid for insurance broker fees	463
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	162
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,426
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $891
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	119
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,875
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,325
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0916280

Policy instance

Insurance contract or identification number	0916280
Number of Individuals Covered	356
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $33,156
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,353,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,170
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	114
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $20,795
Total amount of fees paid to insurance company	USD $491
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,793
Amount paid for insurance broker fees	159
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05948182

Policy instance

Insurance contract or identification number	KM05948182
Number of Individuals Covered	529
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,372
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,372
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	169
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,437
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $539
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	119
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,889
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,333
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

37576000

Policy instance

Insurance contract or identification number	37576000
Number of Individuals Covered	300
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $49,741
Health Insurance Welfare Benefit	Yes
Dental 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 $49,741
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

37576000

Policy instance

Insurance contract or identification number	37576000
Number of Individuals Covered	304
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $51,596
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,338,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	51596
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	130
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,922
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,353
Insurance broker organization code?	3
Insurance broker name	BLLUE CROSS BLUE SHIELD OF KC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50024138

Policy instance

Insurance contract or identification number	50024138
Number of Individuals Covered	168
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,846
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $11,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,154
Insurance broker organization code?	3
Insurance broker name	BLUE CROSS BLUE SHIELD OF KC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30061959

Policy instance

Insurance contract or identification number	30061959
Number of Individuals Covered	114
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $953
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $953
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X58

Policy instance

Insurance contract or identification number	G1X58
Number of Individuals Covered	125
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $21,246
Total amount of fees paid to insurance company	USD $687
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,019
Amount paid for insurance broker fees	318
Insurance broker organization code?	3
Insurance broker name	JOHN BACON

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752718

Policy instance

Insurance contract or identification number	0752718
Number of Individuals Covered	271
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $48,682
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,217,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,682
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS, INC.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	429
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,220
Total amount of fees paid to insurance company	USD $3,546
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,220
Amount paid for insurance broker fees	3546
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS INC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X5B

Policy instance

Insurance contract or identification number	G1X5B
Number of Individuals Covered	111
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $25,149
Total amount of fees paid to insurance company	USD $6,128
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,735
Amount paid for insurance broker fees	2814
Insurance broker organization code?	3
Insurance broker name	JOHN D TYLER

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

G1X5B

Policy instance

Insurance contract or identification number	G1X5B
Number of Individuals Covered	105
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $46,939
Total amount of fees paid to insurance company	USD $11
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,635
Insurance broker organization code?	3
Amount paid for insurance broker fees	11
Insurance broker name	RONALD E KIRKLAND

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	426
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,496
Total amount of fees paid to insurance company	USD $4,765
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,496
Amount paid for insurance broker fees	4765
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752718

Policy instance

Insurance contract or identification number	0752718
Number of Individuals Covered	278
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $53,302
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,173,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,302
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS, INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4011268

Policy instance

Insurance contract or identification number	E4011268
Number of Individuals Covered	95
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,309
Total amount of fees paid to insurance company	USD $227
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $739
Insurance broker organization code?	3
Amount paid for insurance broker fees	156
Insurance broker name	TERRY ALLEN SMITH

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752718

Policy instance

Insurance contract or identification number	0752718
Number of Individuals Covered	319
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $32,411
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $969,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,411
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS, INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4011268

Policy instance

Insurance contract or identification number	E4011268
Number of Individuals Covered	96
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $56,615
Total amount of fees paid to insurance company	USD $32,880
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $117,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,984
Amount paid for insurance broker fees	16143
Insurance broker organization code?	3
Insurance broker name	TERRY ALLEN SMITH

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	434
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,667
Total amount of fees paid to insurance company	USD $1,405
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,667
Amount paid for insurance broker fees	1405
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0752718

Policy instance

Insurance contract or identification number	0752718
Number of Individuals Covered	172
Insurance policy start date	2012-11-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,023
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $175,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,023
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS, INC.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	440
Insurance policy start date	2012-11-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,297
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,297
Insurance broker organization code?	3
Insurance broker name	RPS BENEFITS INC

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

5001026000

Policy instance

Insurance contract or identification number	5001026000
Number of Individuals Covered	47
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $5,052
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	444
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $11,138
Total amount of fees paid to insurance company	USD $843
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

HD154

Policy instance

Insurance contract or identification number	HD154
Number of Individuals Covered	131
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $26,834
Total amount of fees paid to insurance company	USD $561
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COVENTRY HEALTH CARE OF KANSAS, INC. (National Association of Insurance Commissioners NAIC id number: 95489 )

Policy contract number

5001026000

Policy instance

Insurance contract or identification number	5001026000
Number of Individuals Covered	319
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $37,135
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $928,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

5001026000

Policy instance

Insurance contract or identification number	5001026000
Number of Individuals Covered	50
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $4,057
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

HD154

Policy instance

Insurance contract or identification number	HD154
Number of Individuals Covered	162
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $13,992
Total amount of fees paid to insurance company	USD $353
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P6840

Policy instance

Insurance contract or identification number	P6840
Number of Individuals Covered	196
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $10,235
Total amount of fees paid to insurance company	USD $2,317
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COVENTRY HEALTH CARE OF KANSAS, INC. (National Association of Insurance Commissioners NAIC id number: 95489 )

Policy contract number

5001026000

Policy instance

Insurance contract or identification number	5001026000
Number of Individuals Covered	333
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $35,924
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $898,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PENNY'S CONCRETE, INC
Employer identification number (EIN):	480863404
NAIC Classification:	238900