AIR HYDRO POWER, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AIR HYDRO POWER, LLC WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: AIR HYDRO POWER, LLC WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 270 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 276 |
| Total of all active and inactive participants | 2022-10-01 | 276 |
| 2021: AIR HYDRO POWER, LLC WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 285 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 270 |
| Total of all active and inactive participants | 2021-10-01 | 270 |
| 2020: AIR HYDRO POWER, LLC WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 285 |
| Total of all active and inactive participants | 2020-10-01 | 285 |
| 2019: AIR HYDRO POWER, LLC WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 208 |
| Total of all active and inactive participants | 2019-10-01 | 208 |
| 2018: AIR HYDRO POWER, LLC WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 213 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 203 |
| Total of all active and inactive participants | 2018-10-01 | 203 |
| 2017: AIR HYDRO POWER, LLC WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 213 |
| Total of all active and inactive participants | 2017-10-01 | 213 |
| Total participants | 2017-10-01 | 213 |
| 2016: AIR HYDRO POWER, LLC WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 165 |
| Total of all active and inactive participants | 2016-10-01 | 165 |
| Total participants | 2016-10-01 | 165 |
| 2015: AIR HYDRO POWER, LLC WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 156 |
| Total of all active and inactive participants | 2015-10-01 | 156 |
| Total participants | 2015-10-01 | 156 |
| 2014: AIR HYDRO POWER, LLC WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 152 |
| Total of all active and inactive participants | 2014-10-01 | 152 |
| Total participants | 2014-10-01 | 152 |
| Total participants, beginning-of-year | 2014-01-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 136 |
| Total of all active and inactive participants | 2014-01-01 | 136 |
| Total participants | 2014-01-01 | 136 |
| 2013: AIR HYDRO POWER, LLC WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 135 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 135 |
| 2012: AIR HYDRO POWER, LLC WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 98 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Total of all active and inactive participants | 2012-01-01 | 99 |
| 2022: AIR HYDRO POWER, LLC WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: AIR HYDRO POWER, LLC WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: AIR HYDRO POWER, LLC WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: AIR HYDRO POWER, LLC WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: AIR HYDRO POWER, LLC WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: AIR HYDRO POWER, LLC WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: AIR HYDRO POWER, LLC WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: AIR HYDRO POWER, LLC WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: AIR HYDRO POWER, LLC WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: AIR HYDRO POWER, LLC WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: AIR HYDRO POWER, LLC WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26510 |
| Policy instance | 3 |
| Insurance contract or identification number | W26510 | | Number of Individuals Covered | 389 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $154,199 | | 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 number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,556 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $62,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,556 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,996 | | Total amount of fees paid to insurance company | USD $1,964 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,996 | | Amount paid for insurance broker fees | 1964 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $15,280 | | Total amount of fees paid to insurance company | USD $8,820 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $165,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,280 | | Amount paid for insurance broker fees | 8820 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $33,462 | | Total amount of fees paid to insurance company | USD $5,965 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $233,532 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,462 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5965 | | Additional information about fees paid to insurance broker | BONUS |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26510 |
| Policy instance | 3 |
| Insurance contract or identification number | W26510 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $562,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26510 |
| Policy instance | 3 |
| Insurance contract or identification number | W26510 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $486,701 | | 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 number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $29,358 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $195,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,358 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $12,966 | | Total amount of fees paid to insurance company | USD $3,313 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,616 | | Amount paid for insurance broker fees | 1637 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $13,585 | | Total amount of fees paid to insurance company | USD $7,493 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,585 | | Amount paid for insurance broker fees | 7493 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $34,814 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $195,479 | | Commission paid to Insurance Broker | USD $34,814 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26510 |
| Policy instance | 3 |
| Insurance contract or identification number | W26510 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $480,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26510 |
| Policy instance | 3 |
| Insurance contract or identification number | W26510 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Welfare Benefit Premiums Paid to Carrier | USD $448,973 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $12,126 | | Total amount of fees paid to insurance company | USD $3,302 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $132,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,015 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3302 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $26,788 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $188,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,788 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $15,279 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $95,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $9,884 | | Total amount of fees paid to insurance company | USD $3,125 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,174 | | 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 number | 233910 |
| Policy instance | 3 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $10,783 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $72,089 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,783 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 2 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,383 | | Total amount of fees paid to insurance company | USD $742 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,383 | | Amount paid for insurance broker fees | 742 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 03971801 |
| Policy instance | 1 |
| Insurance contract or identification number | 03971801 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $8,453 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,453 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 3 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $10,172 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $65,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,172 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 2 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $2,040 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,040 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 03971801 |
| Policy instance | 1 |
| Insurance contract or identification number | 03971801 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $6,457 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,457 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS |
|
| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 03971801 |
| Policy instance | 1 |
| Insurance contract or identification number | 03971801 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $4,098 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,098 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 233910 |
| Policy instance | 2 |
| Insurance contract or identification number | 233910 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $6,777 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $44,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,777 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 3 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $977 | | Total amount of fees paid to insurance company | USD $1,486 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $932 | | Amount paid for insurance broker fees | 1486 | | Additional information about fees paid to insurance broker | VOLUME INCENTIVES | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS ,LLC |
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 598928 |
| Policy instance | 1 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $37,635 | | Total amount of fees paid to insurance company | USD $5,240 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $34,685 | | Amount paid for insurance broker fees | 5240 | | Additional information about fees paid to insurance broker | VOLUME INCENTIVES | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUGOA11W |
| Policy instance | 2 |
| Insurance contract or identification number | GLUGOA11W | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,178 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $983 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0A11W |
| Policy instance | 3 |
| Insurance contract or identification number | GVTL0A11W | | Number of Individuals Covered | 57 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,674 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,407 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00234694 |
| Policy instance | 4 |
| Insurance contract or identification number | 00234694 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $60 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0A11W |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0A11W | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,353 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,960 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AI1W |
| Policy instance | 5 |
| Insurance contract or identification number | GLTD0AI1W | | Number of Individuals Covered | 130 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,036 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $2,036 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AI1W |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0AI1W | | Number of Individuals Covered | 130 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,102 | | Other welfare benefits provided | LIFE & AD&D | | Commission paid to Insurance Broker | USD $1,102 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 598928 |
| Policy instance | 3 |
| Insurance contract or identification number | 598928 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,553 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $6,553 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0AI1W |
| Policy instance | 2 |
| Insurance contract or identification number | GVTL0AI1W | | Number of Individuals Covered | 59 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,784 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LIFE & AD & D - VOLUNTARY | | Commission paid to Insurance Broker | USD $1,784 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00234694 |
| Policy instance | 1 |
| Insurance contract or identification number | 00234694 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,340 | | Total amount of fees paid to insurance company | USD $8,000 | | Health Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $26,340 | | Amount paid for insurance broker fees | 8000 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED BENEFITS, LLC |
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