BEALL'S INC. & SUBSIDIARIES has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: BEALL'S CHOICE PLUS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-08-01 | 1,989 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 2,003 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
| Total of all active and inactive participants | 2022-08-01 | 2,003 |
| Number of employers contributing to the scheme | 2022-08-01 | 0 |
| 2021: BEALL'S CHOICE PLUS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 2,088 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 1,882 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 21 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 86 |
| Total of all active and inactive participants | 2021-08-01 | 1,989 |
| Number of employers contributing to the scheme | 2021-08-01 | 0 |
| 2020: BEALL'S CHOICE PLUS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 4,436 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 4,074 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
| Total of all active and inactive participants | 2020-08-01 | 4,074 |
| Number of employers contributing to the scheme | 2020-08-01 | 0 |
| 2019: BEALL'S CHOICE PLUS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 4,398 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 4,436 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
| Total of all active and inactive participants | 2019-08-01 | 4,436 |
| Number of employers contributing to the scheme | 2019-08-01 | 0 |
| 2018: BEALL'S CHOICE PLUS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 4,512 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 4,388 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
| Total of all active and inactive participants | 2018-08-01 | 4,398 |
| Number of employers contributing to the scheme | 2018-08-01 | 0 |
| 2017: BEALL'S CHOICE PLUS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 4,595 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 4,501 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 11 |
| Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
| Total of all active and inactive participants | 2017-08-01 | 4,512 |
| Number of employers contributing to the scheme | 2017-08-01 | 0 |
| 2016: BEALL'S CHOICE PLUS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 4,330 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 4,595 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 15 |
| Total of all active and inactive participants | 2016-08-01 | 4,610 |
| Total participants | 2016-08-01 | 4,610 |
| 2015: BEALL'S CHOICE PLUS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 4,229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 4,317 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 13 |
| Total of all active and inactive participants | 2015-08-01 | 4,330 |
| Total participants | 2015-08-01 | 0 |
| 2014: BEALL'S CHOICE PLUS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 3,943 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 4,213 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 16 |
| Total of all active and inactive participants | 2014-08-01 | 4,229 |
| Total participants | 2014-08-01 | 0 |
| 2013: BEALL'S CHOICE PLUS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 3,825 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 3,923 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 20 |
| Total of all active and inactive participants | 2013-08-01 | 3,943 |
| Total participants | 2013-08-01 | 0 |
| 2012: BEALL'S CHOICE PLUS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 4,205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 3,805 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 20 |
| Total of all active and inactive participants | 2012-08-01 | 3,825 |
| Total participants | 2012-08-01 | 0 |
| 2011: BEALL'S CHOICE PLUS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 4,385 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 4,185 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 20 |
| Total of all active and inactive participants | 2011-08-01 | 4,205 |
| Total participants | 2011-08-01 | 4,205 |
| 2010: BEALL'S CHOICE PLUS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-08-01 | 4,381 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-08-01 | 4,361 |
| Number of retired or separated participants receiving benefits | 2010-08-01 | 24 |
| Total of all active and inactive participants | 2010-08-01 | 4,385 |
| Total participants | 2010-08-01 | 4,385 |
| 2009: BEALL'S CHOICE PLUS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 4,747 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 4,235 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 27 |
| Total of all active and inactive participants | 2009-08-01 | 4,262 |
| Total participants | 2009-08-01 | 4,262 |
| Total participants, beginning-of-year | 2009-01-01 | 5,060 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 4,721 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 26 |
| Total of all active and inactive participants | 2009-01-01 | 4,747 |
| Total participants | 2009-01-01 | 4,747 |
| 2022: BEALL'S CHOICE PLUS PLAN 2022 form 5500 responses |
|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: BEALL'S CHOICE PLUS PLAN 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: BEALL'S CHOICE PLUS PLAN 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: BEALL'S CHOICE PLUS PLAN 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: BEALL'S CHOICE PLUS PLAN 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: BEALL'S CHOICE PLUS PLAN 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BEALL'S CHOICE PLUS PLAN 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BEALL'S CHOICE PLUS PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BEALL'S CHOICE PLUS PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BEALL'S CHOICE PLUS PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BEALL'S CHOICE PLUS PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BEALL'S CHOICE PLUS PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BEALL'S CHOICE PLUS PLAN 2010 form 5500 responses |
|---|
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Plan funding arrangement – Insurance | Yes |
| 2010-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BEALL'S CHOICE PLUS PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Submission has been amended | No |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-08-01 | Plan is a collectively bargained plan | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 3 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4475 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $31,669 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $777,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 31669 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 27677 |
| Policy instance | 2 |
| Insurance contract or identification number | 27677 | | Number of Individuals Covered | 1345 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $82,208 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $457,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,208 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 1 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 2003 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2023-07-31 | | Total amount of commissions paid to insurance broker | USD $3,845 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $188,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,845 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 3 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4288 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $881,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 500996 |
| Policy instance | 2 |
| Insurance contract or identification number | 500996 | | Number of Individuals Covered | 867 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $380 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 380 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 1 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 1904 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $3,604 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $184,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,604 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 500996 |
| Policy instance | 2 |
| Insurance contract or identification number | 500996 | | Number of Individuals Covered | 2257 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,018,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 3 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4074 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $728,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 1 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 1903 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $4,070 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $187,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,070 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 3 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4436 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $759,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 1 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 1913 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $4,288 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $200,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,288 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 500996 |
| Policy instance | 2 |
| Insurance contract or identification number | 500996 | | Number of Individuals Covered | 2286 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $240 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,180,854 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 240 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 5 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4388 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $754,396 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 9066 |
| Policy instance | 4 |
| Insurance contract or identification number | 9066 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00500996 |
| Policy instance | 3 |
| Insurance contract or identification number | 00500996 | | Number of Individuals Covered | 2447 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $19,748 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,225,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 19748 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 2 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 2057 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $3,678 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $209,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,678 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 9066 |
| Policy instance | 1 |
| Insurance contract or identification number | 9066 | | Number of Individuals Covered | 2074 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA385028965401 |
| Policy instance | 5 |
| Insurance contract or identification number | SA385028965401 | | Number of Individuals Covered | 4501 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $755,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 9066 |
| Policy instance | 4 |
| Insurance contract or identification number | 9066 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00500996 |
| Policy instance | 3 |
| Insurance contract or identification number | 00500996 | | Number of Individuals Covered | 2469 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $23,486 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,241,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 12224132 |
| Policy instance | 2 |
| Insurance contract or identification number | 12224132 | | Number of Individuals Covered | 2239 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $3,667 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $210,585 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 9066 |
| Policy instance | 1 |
| Insurance contract or identification number | 9066 | | Number of Individuals Covered | 2100 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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