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HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 401k Plan overview

Plan NameHEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC.
Plan identification number 501

HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BRADSHAW AUTOMOTIVE COMPANIES has sponsored the creation of one or more 401k plans.

Company Name:BRADSHAW AUTOMOTIVE COMPANIES
Employer identification number (EIN):570132221
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01STEVE BLACK2023-04-12
5012021-01-01STEVE BLACK2022-07-29
5012020-01-01GEOF CHALLENGER2021-06-02
5012019-01-01GEOFFREY CHALLENGER2020-06-09
5012018-01-01
5012017-01-01
5012016-01-01GEOFFREY CHALLENGER
5012015-01-01GEOFFREY CHALLENGER
5012014-01-01GEOFFREY CHALLENGER
5012013-01-01GEOFFREY CHALLENGER
5012012-01-01GEOFFREY CHALLENGER
5012011-01-01TERESA MEDLIN
5012010-01-01GEOFFREY CHALLENGER GEOFFREY CHALLENGER2011-07-08
5012009-01-01GEOFFREY CHALLENGER GEOFFREY CHALLENGER2010-07-22
5012009-01-01GEOFFREY CHALLENGER GEOFFREY CHALLENGER2010-07-22

Plan Statistics for HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC.

401k plan membership statisitcs for HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC.

Measure Date Value
2022: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-01272
Total number of active participants reported on line 7a of the Form 55002022-01-01265
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01265
Number of employers contributing to the scheme2022-01-010
2021: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01267
Total number of active participants reported on line 7a of the Form 55002021-01-01272
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01272
Number of employers contributing to the scheme2021-01-010
2020: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01282
Total number of active participants reported on line 7a of the Form 55002020-01-01268
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01271
Number of employers contributing to the scheme2020-01-010
2019: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01281
Total number of active participants reported on line 7a of the Form 55002019-01-01281
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01281
Number of employers contributing to the scheme2019-01-010
2018: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01276
Total number of active participants reported on line 7a of the Form 55002018-01-01272
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01272
Number of employers contributing to the scheme2018-01-010
2017: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-01281
Total number of active participants reported on line 7a of the Form 55002017-01-01278
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01278
2016: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01276
Total number of active participants reported on line 7a of the Form 55002016-01-01270
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01270
2015: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01306
Total number of active participants reported on line 7a of the Form 55002015-01-01276
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01276
2014: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01231
Total number of active participants reported on line 7a of the Form 55002014-01-01306
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01306
2013: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01273
Total number of active participants reported on line 7a of the Form 55002013-01-01231
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01231
2012: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01267
Total number of active participants reported on line 7a of the Form 55002012-01-01273
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01273
2011: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2011 401k membership
Total participants, beginning-of-year2011-01-01248
Total number of active participants reported on line 7a of the Form 55002011-01-01267
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01267
2010: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2010 401k membership
Total participants, beginning-of-year2010-01-01251
Total number of active participants reported on line 7a of the Form 55002010-01-01248
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01248
2009: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2009 401k membership
Total participants, beginning-of-year2009-01-01286
Total number of active participants reported on line 7a of the Form 55002009-01-01222
Number of retired or separated participants receiving benefits2009-01-0129
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01251

Form 5500 Responses for HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC.

2022: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: HEALTH BENEFITS PLAN OF EMPLOYEES OF BRADSHAW AUTOMOTIVE GROUP, INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered318
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $46,888
Total amount of fees paid to insurance companyUSD $19,294
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $312,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,888
Amount paid for insurance broker fees19294
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered231
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,658
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,658
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered265
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $45,274
Total amount of fees paid to insurance companyUSD $18,967
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $302,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,274
Amount paid for insurance broker fees18967
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered227
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,772
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,364
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered283
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $45,961
Total amount of fees paid to insurance companyUSD $26,741
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $306,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,961
Amount paid for insurance broker fees26741
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered229
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,575
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,575
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered181
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $48,281
Total amount of fees paid to insurance companyUSD $18,977
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $321,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,281
Amount paid for insurance broker fees18977
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered216
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,614
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,614
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered277
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $40,666
Total amount of fees paid to insurance companyUSD $17,105
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $271,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,666
Amount paid for insurance broker fees17105
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered203
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,584
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,584
Amount paid for insurance broker fees0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL154632
Policy instance 2
Insurance contract or identification numberGL154632
Number of Individuals Covered276
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $41,712
Total amount of fees paid to insurance companyUSD $12,473
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $278,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,712
Amount paid for insurance broker fees12473
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30036691
Policy instance 1
Insurance contract or identification number30036691
Number of Individuals Covered205
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,554
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,554
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.

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