401k Plan data: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN plan

M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	M R WILLIAMS INC EMPLOYEE BENEFIT PLAN
Plan identification number	503

M R WILLIAMS INC EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

M. R. WILLIAMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: M. R. WILLIAMS, INC.

Employer identification number (EIN): 561130993

NAIC Classification: 424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan M R WILLIAMS INC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-09-01
503 2021-09-01
503 2020-09-01
503 2019-09-01
503 2018-09-01
503 2017-09-01
503 2016-09-01 M. LAWSON WILLIAMS
503 2015-09-01 M. LAWSON WILLIAMS
503 2014-09-01 M. LAWSON WILLIAMS
503 2013-09-01 M. LAWSON WILLIAMS
503 2012-09-01 M. LAWSON WILLIAMS
503 2011-09-01 M. LAWSON WILLIAMS
503 2010-09-01 M. LAWSON WILLIAMS
503 2009-09-01 M. LAWSON WILLIAMS

Plan Statistics for M R WILLIAMS INC EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for M R WILLIAMS INC EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-09-01 240
Total number of active participants reported on line 7a of the Form 5500 2022-09-01 247
Total of all active and inactive participants 2022-09-01 247
2021: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 227
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 240
Total of all active and inactive participants 2021-09-01 240
2020: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 263
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 227
Total of all active and inactive participants 2020-09-01 227
2019: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 239
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 263
Total of all active and inactive participants 2019-09-01 263
2018: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-09-01 231
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 239
Total of all active and inactive participants 2018-09-01 239
2017: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 238
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 231
Total of all active and inactive participants 2017-09-01 231
2016: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 222
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 238
Total of all active and inactive participants 2016-09-01 238
2015: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 201
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 222
Total of all active and inactive participants 2015-09-01 222
2014: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 190
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 201
Total of all active and inactive participants 2014-09-01 201
2013: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 184
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 190
Total of all active and inactive participants 2013-09-01 190
2012: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 189
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 184
Total of all active and inactive participants 2012-09-01 184
2011: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 186
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 189
Total of all active and inactive participants 2011-09-01 189
2010: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 200
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 186
Total of all active and inactive participants 2010-09-01 186
2009: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 202
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 200
Total of all active and inactive participants 2009-09-01 200

Measure	Date	Value
2022: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-09-01	240
Total number of active participants reported on line 7a of the Form 5500	2022-09-01	247
Total of all active and inactive participants	2022-09-01	247
2021: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	227
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	240
Total of all active and inactive participants	2021-09-01	240
2020: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	263
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	227
Total of all active and inactive participants	2020-09-01	227
2019: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	239
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	263
Total of all active and inactive participants	2019-09-01	263
2018: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	231
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	239
Total of all active and inactive participants	2018-09-01	239
2017: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	238
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	231
Total of all active and inactive participants	2017-09-01	231
2016: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	222
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	238
Total of all active and inactive participants	2016-09-01	238
2015: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	201
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	222
Total of all active and inactive participants	2015-09-01	222
2014: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	190
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	201
Total of all active and inactive participants	2014-09-01	201
2013: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	184
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	190
Total of all active and inactive participants	2013-09-01	190
2012: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	189
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	184
Total of all active and inactive participants	2012-09-01	184
2011: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	186
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	189
Total of all active and inactive participants	2011-09-01	189
2010: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	200
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	186
Total of all active and inactive participants	2010-09-01	186
2009: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	202
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	200
Total of all active and inactive participants	2009-09-01	200

Form 5500 Responses for M R WILLIAMS INC EMPLOYEE BENEFIT PLAN

2022: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	Plan funding arrangement – Insurance	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes
2021: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2018: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: M R WILLIAMS INC EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	This submission is the final filing	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00230956

Policy instance

Insurance contract or identification number	00230956
Number of Individuals Covered	218
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C5Q7

Policy instance

Insurance contract or identification number	G000C5Q7
Number of Individuals Covered	247
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $1,919
Total amount of fees paid to insurance company	USD $1,250
Other welfare benefits provided	LIFE & AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,919
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	1250

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C5Q7

Policy instance

Insurance contract or identification number	G000C5Q7
Number of Individuals Covered	226
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $5,076
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,076
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C5Q7

Policy instance

Insurance contract or identification number	G000C5Q7
Number of Individuals Covered	225
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $6,103
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,103
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000C5Q7

Policy instance

Insurance contract or identification number	G000C5Q7
Number of Individuals Covered	88
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $1,873
Total amount of fees paid to insurance company	USD $1,250
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFE & AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $18,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,873
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	1250

EXCESS RE (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

S1087-2020

Policy instance

Insurance contract or identification number	S1087-2020
Number of Individuals Covered	218
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCCLOT41044

Policy instance

Insurance contract or identification number	HCCLOT41044
Number of Individuals Covered	218
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	240
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $137
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $137
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	230
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $4,764
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,764
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	230
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $5,696
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,696
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	240
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,488
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,488
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	77
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $120
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120
Insurance broker organization code?	3

EXCESS RE (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

S1087-2020

Policy instance

Insurance contract or identification number	S1087-2020
Number of Individuals Covered	202
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCCLOT41044

Policy instance

Insurance contract or identification number	HCCLOT41044
Number of Individuals Covered	207
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00230956

Policy instance

Insurance contract or identification number	00230956
Number of Individuals Covered	202
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	218
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $4,948
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,948
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	218
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $5,980
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,980
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	227
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $1,556
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC LIFE
Welfare Benefit Premiums Paid to Carrier	USD $15,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,556
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	91
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $145
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $145
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCCLOT41044

Policy instance

Insurance contract or identification number	HCCLOT41044
Number of Individuals Covered	202
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	227
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $141
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $141
Insurance broker organization code?	3

EXCESS RE (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

S1087-2020

Policy instance

Insurance contract or identification number	S1087-2020
Number of Individuals Covered	202
Insurance policy start date	2020-09-01
Insurance policy end date	2021-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCCLOT41044

Policy instance

Insurance contract or identification number	HCCLOT41044
Number of Individuals Covered	246
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $3,213
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,213
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	263
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $145
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $145
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	248
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $4,085
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,085
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	249
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $4,957
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,957
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	263
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $1,593
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC LIFE
Welfare Benefit Premiums Paid to Carrier	USD $15,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,593
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	116
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $164
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $164
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

IISI 3278-19

Policy instance

Insurance contract or identification number	IISI 3278-19
Number of Individuals Covered	246
Insurance policy start date	2019-09-01
Insurance policy end date	2020-08-31
Total amount of commissions paid to insurance broker	USD $1,759
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,759
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	239
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $139
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $139
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	232
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $3,909
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,909
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	233
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $4,743
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,743
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	239
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $1,527
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC LIFE
Welfare Benefit Premiums Paid to Carrier	USD $15,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,527
Insurance broker organization code?	3

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	113
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $168
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $168
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

IISI 3278-18

Policy instance

Insurance contract or identification number	IISI 3278-18
Number of Individuals Covered	239
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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

947-6865

Policy instance

Insurance contract or identification number	947-6865
Number of Individuals Covered	224
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	224
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $3,327
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	225
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $4,210
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	231
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $1,514
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC LIFE
Welfare Benefit Premiums Paid to Carrier	USD $15,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	111
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $162
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

IISI 3278-17.

Policy instance

Insurance contract or identification number	IISI 3278-17.
Number of Individuals Covered	231
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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

947-4054

Policy instance

Insurance contract or identification number	947-4054
Number of Individuals Covered	231
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN TRANSPLANT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00615110

Policy instance

Insurance contract or identification number	G 00615110
Number of Individuals Covered	231
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $138
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	M. R. WILLIAMS, INC.
Employer identification number (EIN):	561130993
NAIC Classification:	424400