BERNHARDT FURNITURE COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2023: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 1,213 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 1,161 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 8 |
| Total of all active and inactive participants | 2023-01-01 | 1,169 |
| 2022: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,209 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 4 |
| Total of all active and inactive participants | 2022-01-01 | 1,213 |
| 2021: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,229 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 4 |
| Total of all active and inactive participants | 2021-01-01 | 1,233 |
| 2020: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,409 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,154 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 21 |
| Total of all active and inactive participants | 2020-01-01 | 1,175 |
| 2019: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,424 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,400 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 9 |
| Total of all active and inactive participants | 2019-01-01 | 1,409 |
| 2018: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,479 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,413 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 11 |
| Total of all active and inactive participants | 2018-01-01 | 1,424 |
| 2017: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,432 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,471 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 8 |
| Total of all active and inactive participants | 2017-01-01 | 1,479 |
| 2016: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,298 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,276 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 156 |
| Total of all active and inactive participants | 2016-01-01 | 1,432 |
| 2015: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,095 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,161 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 137 |
| Total of all active and inactive participants | 2015-01-01 | 1,298 |
| 2014: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 1,080 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 1,095 |
| Total of all active and inactive participants | 2014-11-01 | 1,095 |
| 2013: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 1,021 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 1,080 |
| Total of all active and inactive participants | 2013-11-01 | 1,080 |
| 2012: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 898 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 1,021 |
| Total of all active and inactive participants | 2012-11-01 | 1,021 |
| 2011: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 842 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 898 |
| Total of all active and inactive participants | 2011-11-01 | 898 |
| 2009: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 853 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 777 |
| Number of retired or separated participants receiving benefits | 2009-11-01 | 47 |
| Total of all active and inactive participants | 2009-11-01 | 824 |
| Measure | Date | Value |
|---|
| 2014 : BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $2,275 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $21,545 |
| Total income from all sources (including contributions) | 2014-10-31 | $10,910,574 |
| Total of all expenses incurred | 2014-10-31 | $11,215,026 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-10-31 | $10,003,497 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-10-31 | $10,910,574 |
| Value of total assets at end of year | 2014-10-31 | $88,581 |
| Value of total assets at beginning of year | 2014-10-31 | $412,303 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-10-31 | $1,211,529 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-10-31 | No |
| Was this plan covered by a fidelity bond | 2014-10-31 | Yes |
| Value of fidelity bond cover | 2014-10-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-10-31 | No |
| Contributions received from participants | 2014-10-31 | $2,715,855 |
| Assets. Other investments not covered elsewhere at end of year | 2014-10-31 | $88,581 |
| Assets. Other investments not covered elsewhere at beginning of year | 2014-10-31 | $75,618 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-10-31 | $2,275 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-10-31 | $21,545 |
| Administrative expenses (other) incurred | 2014-10-31 | $558,754 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-10-31 | No |
| Value of net income/loss | 2014-10-31 | $-304,452 |
| Value of net assets at end of year (total assets less liabilities) | 2014-10-31 | $86,306 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-10-31 | $390,758 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-10-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-10-31 | $336,685 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-10-31 | $336,685 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-10-31 | No |
| Contributions received in cash from employer | 2014-10-31 | $8,194,719 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-10-31 | $10,003,497 |
| Contract administrator fees | 2014-10-31 | $652,775 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-10-31 | No |
| Did the plan have assets held for investment | 2014-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-10-31 | Unqualified |
| Accountancy firm name | 2014-10-31 | DAVIDSON, HOLLAND, WHITESELL & CO., |
| Accountancy firm EIN | 2014-10-31 | 561706742 |
| 2013 : BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-10-31 | $21,545 |
| Total income from all sources (including contributions) | 2013-10-31 | $7,510,962 |
| Total of all expenses incurred | 2013-10-31 | $8,810,429 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-10-31 | $8,124,099 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-10-31 | $7,510,962 |
| Value of total assets at end of year | 2013-10-31 | $412,303 |
| Value of total assets at beginning of year | 2013-10-31 | $1,690,225 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-10-31 | $686,330 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-10-31 | No |
| Was this plan covered by a fidelity bond | 2013-10-31 | Yes |
| Value of fidelity bond cover | 2013-10-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-10-31 | No |
| Contributions received from participants | 2013-10-31 | $2,542,482 |
| Assets. Other investments not covered elsewhere at end of year | 2013-10-31 | $75,618 |
| Assets. Other investments not covered elsewhere at beginning of year | 2013-10-31 | $1,246,681 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-10-31 | $21,545 |
| Administrative expenses (other) incurred | 2013-10-31 | $155,452 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-10-31 | No |
| Value of net income/loss | 2013-10-31 | $-1,299,467 |
| Value of net assets at end of year (total assets less liabilities) | 2013-10-31 | $390,758 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-10-31 | $1,690,225 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-10-31 | $336,685 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-10-31 | $443,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-10-31 | $443,544 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-10-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-10-31 | No |
| Contributions received in cash from employer | 2013-10-31 | $4,968,480 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-10-31 | $8,124,099 |
| Contract administrator fees | 2013-10-31 | $530,878 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-10-31 | No |
| Did the plan have assets held for investment | 2013-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-10-31 | Unqualified |
| Accountancy firm name | 2013-10-31 | DAVIDSON, HOLLAND, WHITESELL & CO., |
| Accountancy firm EIN | 2013-10-31 | 561706742 |
| 2012 : BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2012 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $81,888 |
| Total income from all sources (including contributions) | 2012-10-31 | $9,025,980 |
| Total of all expenses incurred | 2012-10-31 | $8,525,651 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-10-31 | $8,148,241 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-10-31 | $9,010,181 |
| Value of total assets at end of year | 2012-10-31 | $1,690,225 |
| Value of total assets at beginning of year | 2012-10-31 | $1,271,784 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-10-31 | $377,410 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-10-31 | No |
| Was this plan covered by a fidelity bond | 2012-10-31 | Yes |
| Value of fidelity bond cover | 2012-10-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-10-31 | No |
| Contributions received from participants | 2012-10-31 | $2,149,258 |
| Assets. Other investments not covered elsewhere at end of year | 2012-10-31 | $1,246,681 |
| Assets. Other investments not covered elsewhere at beginning of year | 2012-10-31 | $1,250,473 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-10-31 | $81,888 |
| Other income not declared elsewhere | 2012-10-31 | $15,799 |
| Administrative expenses (other) incurred | 2012-10-31 | $135,913 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Value of net income/loss | 2012-10-31 | $500,329 |
| Value of net assets at end of year (total assets less liabilities) | 2012-10-31 | $1,690,225 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-10-31 | $1,189,896 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-10-31 | $443,544 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-10-31 | $21,311 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-10-31 | $21,311 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-10-31 | $18,922 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-10-31 | No |
| Contributions received in cash from employer | 2012-10-31 | $6,860,923 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-10-31 | $8,129,319 |
| Contract administrator fees | 2012-10-31 | $241,497 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-10-31 | No |
| Did the plan have assets held for investment | 2012-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-10-31 | Unqualified |
| Accountancy firm name | 2012-10-31 | DAVIDSON, HOLLAND, WHITESELL & CO., |
| Accountancy firm EIN | 2012-10-31 | 561706742 |
| 2011 : BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $81,888 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $32,449 |
| Total income from all sources (including contributions) | 2011-10-31 | $7,650,502 |
| Total of all expenses incurred | 2011-10-31 | $7,763,086 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-10-31 | $7,286,424 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-10-31 | $7,624,818 |
| Value of total assets at end of year | 2011-10-31 | $1,271,784 |
| Value of total assets at beginning of year | 2011-10-31 | $1,334,929 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-10-31 | $476,662 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-10-31 | No |
| Was this plan covered by a fidelity bond | 2011-10-31 | Yes |
| Value of fidelity bond cover | 2011-10-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-10-31 | No |
| Contributions received from participants | 2011-10-31 | $2,104,675 |
| Participant contributions at end of year | 2011-10-31 | $0 |
| Participant contributions at beginning of year | 2011-10-31 | $28,116 |
| Assets. Other investments not covered elsewhere at end of year | 2011-10-31 | $1,250,473 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-10-31 | $1,222,062 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-10-31 | $81,888 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-10-31 | $32,449 |
| Other income not declared elsewhere | 2011-10-31 | $25,684 |
| Administrative expenses (other) incurred | 2011-10-31 | $126,903 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Value of net income/loss | 2011-10-31 | $-112,584 |
| Value of net assets at end of year (total assets less liabilities) | 2011-10-31 | $1,189,896 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-10-31 | $1,302,480 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-10-31 | $21,311 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-10-31 | $84,751 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-10-31 | $84,751 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-10-31 | $67,269 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-10-31 | No |
| Contributions received in cash from employer | 2011-10-31 | $5,520,143 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-10-31 | $7,219,155 |
| Contract administrator fees | 2011-10-31 | $349,759 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-10-31 | No |
| Did the plan have assets held for investment | 2011-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-10-31 | Unqualified |
| Accountancy firm name | 2011-10-31 | DAVIDSON, HOLLAND, WHITESELL & CO., |
| Accountancy firm EIN | 2011-10-31 | 561706742 |
| 2023: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – Trust | Yes |
| 2013-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement - Trust | Yes |
| 2013-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – Trust | Yes |
| 2012-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement - Trust | Yes |
| 2012-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: BERNHARDT FURNITURE COMPANY HEALTH CARE 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 funding arrangement – Trust | Yes |
| 2011-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement - Trust | Yes |
| 2011-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: BERNHARDT FURNITURE COMPANY HEALTH CARE PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – Trust | Yes |
| 2009-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement - Trust | Yes |
| 2009-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 141672919001 |
| Policy instance | 8 |
| Insurance contract or identification number | 141672919001 | | Number of Individuals Covered | 923 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0244330 |
| Policy instance | 1 |
| Insurance contract or identification number | 0244330 | | Number of Individuals Covered | 3906 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $125,798 | | Total amount of fees paid to insurance company | USD $8,732 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,218,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155882 |
| Policy instance | 2 |
| Insurance contract or identification number | GTP0009155882 | | Number of Individuals Covered | 1161 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 3 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $14,470 | | Total amount of fees paid to insurance company | USD $5,788 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | BERNHARDT FURNI |
| Policy instance | 4 |
| Insurance contract or identification number | BERNHARDT FURNI | | Number of Individuals Covered | 1620 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,136 | | 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: 65675 ) |
| Policy contract number | SA3890LF024801 |
| Policy instance | 5 |
| Insurance contract or identification number | SA3890LF024801 | | Number of Individuals Covered | 1231 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,812 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,120 | | 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: 65675 ) |
| Policy contract number | GF3890LF024801 |
| Policy instance | 6 |
| Insurance contract or identification number | GF3890LF024801 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $406 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,060 | | 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: 65675 ) |
| Policy contract number | GD3890LF024801 |
| Policy instance | 7 |
| Insurance contract or identification number | GD3890LF024801 | | Number of Individuals Covered | 756 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $3,936 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,682 | | 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: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 1 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 948 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $25,213 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $504,254 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,213 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155882 |
| Policy instance | 2 |
| Insurance contract or identification number | GTP0009155882 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,065 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,065 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 3 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $12,287 | | Total amount of fees paid to insurance company | USD $4,915 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,287 | | Amount paid for insurance broker fees | 4915 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL36314 |
| Policy instance | 4 |
| Insurance contract or identification number | HCL36314 | | Number of Individuals Covered | 975 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $10,817 | | Welfare Benefit Premiums Paid to Carrier | USD $216,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 10817 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | BERNHARDT FURNI |
| Policy instance | 5 |
| Insurance contract or identification number | BERNHARDT FURNI | | Number of Individuals Covered | 1631 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,307 | | 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: 65675 ) |
| Policy contract number | SA3890LF024801 |
| Policy instance | 6 |
| Insurance contract or identification number | SA3890LF024801 | | Number of Individuals Covered | 1245 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $35,754 | | Total amount of fees paid to insurance company | USD $5,643 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $357,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,754 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BROKER FEES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | GF3890LF024801 |
| Policy instance | 7 |
| Insurance contract or identification number | GF3890LF024801 | | Number of Individuals Covered | 220 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,695 | | Total amount of fees paid to insurance company | USD $684 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,951 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,695 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BROKER FEES |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | GD3890LF024801 |
| Policy instance | 8 |
| Insurance contract or identification number | GD3890LF024801 | | Number of Individuals Covered | 760 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $51,782 | | Total amount of fees paid to insurance company | USD $3,962 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $258,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,782 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BROKER FEES |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 141672919001 |
| Policy instance | 9 |
| Insurance contract or identification number | 141672919001 | | Number of Individuals Covered | 969 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 1 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 950 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $25,500 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $510,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,500 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155882 |
| Policy instance | 2 |
| Insurance contract or identification number | GTP0009155882 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 3 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,823 | | Total amount of fees paid to insurance company | USD $4,729 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,823 | | Amount paid for insurance broker fees | 4729 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL36314 |
| Policy instance | 4 |
| Insurance contract or identification number | HCL36314 | | Number of Individuals Covered | 951 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $-884 | | Total amount of fees paid to insurance company | USD $10,283 | | Welfare Benefit Premiums Paid to Carrier | USD $187,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 10283 | | Additional information about fees paid to insurance broker | MEDICAL | | Insurance broker organization code? | 3 |
|
| COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | BERNHARDT FURNI |
| Policy instance | 5 |
| Insurance contract or identification number | BERNHARDT FURNI | | Number of Individuals Covered | 1003 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $147,528 | | 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: 65675 ) |
| Policy contract number | SA3890LF024801 |
| Policy instance | 6 |
| Insurance contract or identification number | SA3890LF024801 | | Number of Individuals Covered | 1216 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $36,095 | | Total amount of fees paid to insurance company | USD $12,281 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $360,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,095 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | GF3890LF024801 |
| Policy instance | 7 |
| Insurance contract or identification number | GF3890LF024801 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,965 | | Total amount of fees paid to insurance company | USD $1,254 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,965 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | GD3890LF024801 |
| Policy instance | 8 |
| Insurance contract or identification number | GD3890LF024801 | | Number of Individuals Covered | 750 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $48,684 | | Total amount of fees paid to insurance company | USD $8,447 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $243,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,684 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 141672919001 |
| Policy instance | 9 |
| Insurance contract or identification number | 141672919001 | | Number of Individuals Covered | 971 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $96,853 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $96,853 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3890LF024801 |
| Policy instance | 8 |
| Insurance contract or identification number | GD3890LF024801 | | Number of Individuals Covered | 755 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $47,031 | | Total amount of fees paid to insurance company | USD $9,291 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $235,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,031 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| LINCOLN LIFE INSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3890LF024801 |
| Policy instance | 7 |
| Insurance contract or identification number | GF3890LF024801 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,239 | | Total amount of fees paid to insurance company | USD $1,509 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,315 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,239 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3890LF024801 |
| Policy instance | 6 |
| Insurance contract or identification number | SA3890LF024801 | | Number of Individuals Covered | 1152 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $33,534 | | Total amount of fees paid to insurance company | USD $13,653 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $343,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,534 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | BERNHARDT FURNI |
| Policy instance | 5 |
| Insurance contract or identification number | BERNHARDT FURNI | | Number of Individuals Covered | 1696 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927080 |
| Policy instance | 4 |
| Insurance contract or identification number | 927080 | | Number of Individuals Covered | 965 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $-640 | | Total amount of fees paid to insurance company | USD $3,644 | | Welfare Benefit Premiums Paid to Carrier | USD $231,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-640 | | Amount paid for insurance broker fees | 3644 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 3 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,872 | | Total amount of fees paid to insurance company | USD $4,749 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,872 | | Amount paid for insurance broker fees | 4749 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155882 |
| Policy instance | 2 |
| Insurance contract or identification number | GTP0009155882 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | 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: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 1 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 937 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $26,915 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $538,291 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,915 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154959 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 154959 | | Number of Individuals Covered | 1413 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,481 | | Total amount of fees paid to insurance company | USD $622 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $54,805 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,481 | | Amount paid for insurance broker fees | 622 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154960 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 154960 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $25,718 | | Total amount of fees paid to insurance company | USD $3,313 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $257,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,718 | | Amount paid for insurance broker fees | 3313 | | Insurance broker organization code? | 3 |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 3 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 1087 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $28,154 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $563,083 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,998 | | Insurance broker organization code? | 3 |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 126802 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 126802 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,440 | | Total amount of fees paid to insurance company | USD $653 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,440 | | Amount paid for insurance broker fees | 653 | | Insurance broker organization code? | 3 |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 326915 |
| Policy instance | 5 |
| Insurance contract or identification number | VPS 326915 | | Number of Individuals Covered | 967 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $70,874 | | Total amount of fees paid to insurance company | USD $3,879 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $354,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,874 | | Amount paid for insurance broker fees | 3879 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206946 |
| Policy instance | 6 |
| Insurance contract or identification number | VAR 206946 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $707 | | Total amount of fees paid to insurance company | USD $91 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $707 | | Amount paid for insurance broker fees | 91 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155882 |
| Policy instance | 7 |
| Insurance contract or identification number | GTP0009155882 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,065 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $7,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,065 | | Insurance broker organization code? | 3 |
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| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 8 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,539 | | Total amount of fees paid to insurance company | USD $4,615 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,539 | | Amount paid for insurance broker fees | 4615 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 927080 |
| Policy instance | 9 |
| Insurance contract or identification number | 927080 | | Number of Individuals Covered | 1214 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $26,177 | | Total amount of fees paid to insurance company | USD $5,466 | | Welfare Benefit Premiums Paid to Carrier | USD $254,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,177 | | Amount paid for insurance broker fees | 5466 | | Insurance broker organization code? | 3 |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154959 |
| Policy instance | 1 |
| Insurance contract or identification number | GL 154959 | | Number of Individuals Covered | 1411 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,979 | | Total amount of fees paid to insurance company | USD $648 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $49,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,979 | | Amount paid for insurance broker fees | 648 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154960 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 154960 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $26,508 | | Total amount of fees paid to insurance company | USD $3,439 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $265,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,508 | | Amount paid for insurance broker fees | 3439 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 3 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 1104 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $27,460 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $549,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,460 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 126802 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD 126802 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,221 | | Total amount of fees paid to insurance company | USD $638 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,221 | | Amount paid for insurance broker fees | 638 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 326915 |
| Policy instance | 5 |
| Insurance contract or identification number | VPS 326915 | | Number of Individuals Covered | 1015 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $62,070 | | Total amount of fees paid to insurance company | USD $3,873 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $310,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,070 | | Amount paid for insurance broker fees | 3873 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206946 |
| Policy instance | 6 |
| Insurance contract or identification number | VAR 206946 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $729 | | Total amount of fees paid to insurance company | USD $15 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $729 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
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| UNITED HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 62111 ) |
| Policy contract number | 912690 |
| Policy instance | 7 |
| Insurance contract or identification number | 912690 | | Number of Individuals Covered | 1209 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $71,090 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,545 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL961973 |
| Policy instance | 8 |
| Insurance contract or identification number | ABL961973 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $541 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $3,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $541 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7712-18 |
| Policy instance | 9 |
| Insurance contract or identification number | 4EL-7712-18 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $13,056 | | Total amount of fees paid to insurance company | USD $5,222 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,056 | | Amount paid for insurance broker fees | 5222 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154959 |
| Policy instance | 2 |
| Insurance contract or identification number | GL 154959 | | Number of Individuals Covered | 1471 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,183 | | Total amount of fees paid to insurance company | USD $542 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $51,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,183 | | Amount paid for insurance broker fees | 542 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 154960 |
| Policy instance | 3 |
| Insurance contract or identification number | GL 154960 | | Number of Individuals Covered | 1033 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $27,513 | | Total amount of fees paid to insurance company | USD $3,213 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $280,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,513 | | Amount paid for insurance broker fees | 3213 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 40D011950 |
| Policy instance | 4 |
| Insurance contract or identification number | 40D011950 | | Number of Individuals Covered | 1106 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $28,324 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $566,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,324 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 126802 |
| Policy instance | 5 |
| Insurance contract or identification number | LTD 126802 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,103 | | Total amount of fees paid to insurance company | USD $559 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,103 | | Amount paid for insurance broker fees | 559 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS 326915 |
| Policy instance | 6 |
| Insurance contract or identification number | VPS 326915 | | Number of Individuals Covered | 1051 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $61,965 | | Total amount of fees paid to insurance company | USD $3,408 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $309,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,965 | | Amount paid for insurance broker fees | 3408 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR 206946 |
| Policy instance | 7 |
| Insurance contract or identification number | VAR 206946 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $122 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $122 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
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| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 075331 |
| Policy instance | 1 |
| Insurance contract or identification number | 075331 | | Number of Individuals Covered | 1220 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $74,939 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74,939 | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT FLOYD |
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