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EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameEARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 505

EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 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
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

EARL W. COLVARD, INC. has sponsored the creation of one or more 401k plans.

Company Name:EARL W. COLVARD, INC.
Employer identification number (EIN):592183177
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Additional information about EARL W. COLVARD, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1982-04-28
Company Identification Number: F78841
Legal Registered Office Address: 816 S WOODLAND BLVD

DELAND

32720

More information about EARL W. COLVARD, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-11-01YAN LAPOINTE2024-04-24
5052021-11-01YAN LAPOINTE2023-04-26
5052019-11-01YAN LAPOINTE2021-05-18
5052018-11-01YAN LAPOINTE2020-08-12
5052017-11-01CHERYL KERVIN2019-07-05
5052016-11-01CHERYL KERVIN
5052015-11-01CHERYL KERVIN
5052014-11-01CHERYL KERVIN
5052013-11-01CHERYL KERVIN

Plan Statistics for EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-11-01657
Total number of active participants reported on line 7a of the Form 55002022-11-01662
Total of all active and inactive participants2022-11-01662
2021: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-011,214
Total number of active participants reported on line 7a of the Form 55002021-11-01657
Total of all active and inactive participants2021-11-01657
2019: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01595
Total number of active participants reported on line 7a of the Form 55002019-11-011,110
Total of all active and inactive participants2019-11-011,110
2018: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01455
Total number of active participants reported on line 7a of the Form 55002018-11-01595
Total of all active and inactive participants2018-11-01595
2017: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01468
Total number of active participants reported on line 7a of the Form 55002017-11-01455
Total of all active and inactive participants2017-11-01455
2016: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01469
Total number of active participants reported on line 7a of the Form 55002016-11-01468
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01468
2015: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01486
Total number of active participants reported on line 7a of the Form 55002015-11-01469
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01469
2014: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01448
Total number of active participants reported on line 7a of the Form 55002014-11-01486
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01486
2013: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01438
Total number of active participants reported on line 7a of the Form 55002013-11-01448
Total of all active and inactive participants2013-11-01448

Form 5500 Responses for EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN

2022: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-11-01Type of plan entitySingle employer plan
2022-11-01Plan funding arrangement – InsuranceYes
2022-11-01Plan benefit arrangement – InsuranceYes
2021: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – InsuranceYes
2019: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2018: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2015: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes
2014: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: EARL W. COLVARD, INC. AND BOULEVARD RETREAD CENTER, INC. HEALTH AND WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01First time form 5500 has been submittedYes
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918559
Policy instance 2
Insurance contract or identification number918559
Number of Individuals Covered662
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $34,873
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $557,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,873
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 1
Insurance contract or identification number0837869
Number of Individuals Covered466
Insurance policy start date2022-11-01
Insurance policy end date2023-10-31
Total amount of commissions paid to insurance brokerUSD $4,323
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,116,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,323
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918559
Policy instance 3
Insurance contract or identification number918559
Number of Individuals Covered638
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $8,838
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,838
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 2
Insurance contract or identification number229425
Number of Individuals Covered657
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $42,835
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $409,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,835
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 1
Insurance contract or identification number0837869
Number of Individuals Covered477
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $4,360
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,376,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,360
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 1
Insurance contract or identification number0837869
Number of Individuals Covered469
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $4,428
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $190,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,428
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 2
Insurance contract or identification number229425
Number of Individuals Covered553
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $40,902
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $334,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,902
Insurance broker organization code?3
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number0837869HNO
Policy instance 3
Insurance contract or identification number0837869HNO
Number of Individuals Covered526
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $3,397,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918559
Policy instance 4
Insurance contract or identification number918559
Number of Individuals Covered1110
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $8,828
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,828
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number918559
Policy instance 4
Insurance contract or identification number918559
Number of Individuals Covered595
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $4,561
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,561
Insurance broker organization code?3
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number0837869HNO
Policy instance 3
Insurance contract or identification number0837869HNO
Number of Individuals Covered581
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $2,802,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 2
Insurance contract or identification number229425
Number of Individuals Covered575
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $34,132
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $268,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,132
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 1
Insurance contract or identification number0837869
Number of Individuals Covered489
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $3,767
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $115,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,767
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5481979
Policy instance 2
Insurance contract or identification number5481979
Number of Individuals Covered455
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,362
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $157,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 1
Insurance contract or identification number0837869
Number of Individuals Covered330
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,222
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number0837869HNO
Policy instance 4
Insurance contract or identification number0837869HNO
Number of Individuals Covered439
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $2,569,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 3
Insurance contract or identification number229425
Number of Individuals Covered445
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $32,673
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $255,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0837869
Policy instance 3
Insurance contract or identification number0837869
Number of Individuals Covered372
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameWILLIAM T. KURTZ
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 2
Insurance contract or identification number229425
Number of Individuals Covered422
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $47,068
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $376,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,841
Insurance broker organization code?3
Insurance broker nameCORISH & COMPANY
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number0837869HNO
Policy instance 1
Insurance contract or identification number0837869HNO
Number of Individuals Covered486
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $65,842
Welfare Benefit Premiums Paid to CarrierUSD $1,783,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,747
Insurance broker organization code?3
Insurance broker nameCORISH & COMPANY, INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number229425
Policy instance 2
Insurance contract or identification number229425
Number of Individuals Covered396
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $40,705
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $348,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,705
Insurance broker organization code?3
Insurance broker nameWILLIAM T. KURTZ
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 )
Policy contract number0837869HNO
Policy instance 1
Insurance contract or identification number0837869HNO
Number of Individuals Covered448
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $58,013
Welfare Benefit Premiums Paid to CarrierUSD $1,886,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,013
Insurance broker organization code?3
Insurance broker nameWILLIAM T. KURTZ

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