JAMES R. VANNOY & SONS CONSTRUCTION COMPANY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN
| Measure | Date | Value |
|---|
| 2023 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2023 401k financial data |
|---|
| Total income from all sources | 2023-12-31 | $0 |
| Total plan assets at end of year | 2023-12-31 | $0 |
| Total plan assets at beginning of year | 2023-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $0 |
| 2022 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $0 |
| Total plan assets at beginning of year | 2022-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $0 |
| 2021 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| 2020 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $0 |
| Total plan assets at end of year | 2020-12-31 | $0 |
| Total plan assets at beginning of year | 2020-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $0 |
| 2019 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $0 |
| Total plan assets at end of year | 2019-12-31 | $0 |
| Total plan assets at beginning of year | 2019-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
| 2018 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $0 |
| Total plan assets at end of year | 2018-12-31 | $0 |
| Total plan assets at beginning of year | 2018-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $0 |
| 2017 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $0 |
| Total plan assets at end of year | 2017-12-31 | $0 |
| Total plan assets at beginning of year | 2017-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| 2016 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $0 |
| Total plan assets at end of year | 2016-12-31 | $0 |
| Total plan assets at beginning of year | 2016-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| 2015 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $0 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| 2014 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Did the plan have assets held for investment | 2014-12-31 | No |
| 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 | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| 2013 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $0 |
| Total plan assets at end of year | 2013-12-31 | $0 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| 2012 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $0 |
| Total plan assets at end of year | 2012-12-31 | $0 |
| Total plan assets at beginning of year | 2012-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $0 |
| 2011 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $0 |
| Total plan assets at end of year | 2011-12-31 | $0 |
| Total plan assets at beginning of year | 2011-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $0 |
| 2010 : JAMES R VANNOY & SONS CONSTRUCTION COMPANY SECTION 125 PLAN 2010 401k financial data |
|---|
| Total plan assets at end of year | 2010-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $0 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 7 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $4,808 | | Other welfare benefits provided | ECR CRITICAL CARE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1005 |
| Policy instance | 17 |
| Insurance contract or identification number | 14162580-1005 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $2,967 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1001 |
| Policy instance | 1 |
| Insurance contract or identification number | 14162580-1001 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $92,384 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 2 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $22,628 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 3 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $4,881 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 4 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $6,642 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 5 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $30,005 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 6 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $5,154 | | Other welfare benefits provided | ECR ACCIDENT RECOVERY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 8 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $3,433 | | Other welfare benefits provided | VOLUNTARY ACCIDENTAL DEATH & DISMEM | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 9 |
| Number of Individuals Covered | 281 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of fees paid to insurance company | USD $3,997 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1003 |
| Policy instance | 15 |
| Insurance contract or identification number | 14162580-1003 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $1,561 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1011 |
| Policy instance | 14 |
| Insurance contract or identification number | 14162580-1011 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $1,454 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1009 |
| Policy instance | 13 |
| Insurance contract or identification number | 14162580-1009 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $1,472 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1007 |
| Policy instance | 12 |
| Insurance contract or identification number | 14162580-1007 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $793 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 11 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $9,361 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 10 |
| Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of fees paid to insurance company | USD $60 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1013 |
| Policy instance | 16 |
| Insurance contract or identification number | 14162580-1013 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $648 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WELLNESS | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 7 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $11,204 | | Other welfare benefits provided | OTHER (SPECIFY) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 6 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $8,598 | | Other welfare benefits provided | OTHER (SPECIFY) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 5 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $29,730 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 4 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-30 | | Total amount of commissions paid to insurance broker | USD $5,966 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 3 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $5,463 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (SPECIFY) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 2 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $22,545 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1001 |
| Policy instance | 1 |
| Insurance contract or identification number | 14162580-1001 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $35,809 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 8 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $3,504 | | Other welfare benefits provided | OTHER (SPECIFY) | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 9 |
| Number of Individuals Covered | 290 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of fees paid to insurance company | USD $3,498 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 10 |
| Number of Individuals Covered | 5 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of fees paid to insurance company | USD $48 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1011 |
| Policy instance | 14 |
| Insurance contract or identification number | 14162580-1011 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $400 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1005 |
| Policy instance | 17 |
| Insurance contract or identification number | 14162580-1005 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $1,147 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1013 |
| Policy instance | 16 |
| Insurance contract or identification number | 14162580-1013 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $590 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1003 |
| Policy instance | 15 |
| Insurance contract or identification number | 14162580-1003 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $154 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1009 |
| Policy instance | 13 |
| Insurance contract or identification number | 14162580-1009 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $537 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 14162580-1007 |
| Policy instance | 12 |
| Insurance contract or identification number | 14162580-1007 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $332 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 11 |
| Insurance contract or identification number | 50035775 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $9,486 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 4 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 6 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 7 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 8 |
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 9 |
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 10 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 4 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 6 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 7 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50035775 |
| Policy instance | 8 |
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 9 |
| FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | |
| Policy instance | 10 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-6 |
| Policy instance | 6 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-6 |
| Policy instance | 5 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-6 |
| Policy instance | 4 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-6 |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-6 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | V32252 |
| Policy instance | 7 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-0 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1066765 |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-0 |
| Policy instance | 4 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-0 |
| Policy instance | 5 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-0 |
| Policy instance | 6 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70169-0 |
| Policy instance | 7 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50012337 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1066765 |
| Policy instance | 4 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1066765 |
| Policy instance | 3 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00611353 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 9071480495 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00611353 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00611353 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00611353 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001264 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50001264 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) |
| Policy contract number | 032252 |
| Policy instance | 1 |
