VIVID IMPACT COMPANY, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VIVID IMPACT COMPANY WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 187 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 2 |
| Total of all active and inactive participants | 2023-01-01 | 189 |
| 2022: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 186 |
| Total of all active and inactive participants | 2022-01-01 | 186 |
| 2021: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 157 |
| Total of all active and inactive participants | 2021-01-01 | 157 |
| 2020: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 145 |
| Total of all active and inactive participants | 2020-01-01 | 145 |
| 2019: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 149 |
| Total of all active and inactive participants | 2019-01-01 | 149 |
| 2018: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 156 |
| Total of all active and inactive participants | 2018-03-01 | 156 |
| 2017: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 131 |
| Total of all active and inactive participants | 2017-03-01 | 131 |
| 2016: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 121 |
| Total of all active and inactive participants | 2016-03-01 | 121 |
| 2015: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 146 |
| Total of all active and inactive participants | 2015-03-01 | 146 |
| 2014: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 146 |
| Total of all active and inactive participants | 2014-03-01 | 146 |
| 2023: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – Insurance | Yes |
| 2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – Insurance | Yes |
| 2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: VIVID IMPACT COMPANY WELFARE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | First time form 5500 has been submitted | Yes |
| 2014-03-01 | Plan funding arrangement – Insurance | Yes |
| 2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | L08711 |
| Policy instance | 4 |
| Insurance contract or identification number | L08711 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2023-09-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $7,950 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $237,813 | | 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 | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $3,183 | | Total amount of fees paid to insurance company | USD $2,192 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,749 | | 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 | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $10,205 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, ACCIDENT, VOL CRIT ILL | | Welfare Benefit Premiums Paid to Carrier | USD $58,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $27,242 | | Total amount of fees paid to insurance company | USD $2,372 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $516,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $37,822 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $709,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,822 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,672 | | Total amount of fees paid to insurance company | USD $881 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT LIFE, VOL CRT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $56,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,672 | | Amount paid for insurance broker fees | 881 | | Additional information about fees paid to insurance broker | CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,528 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,528 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $959 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $959 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,237 | | Total amount of fees paid to insurance company | USD $4,517 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT LIFE, VOL CRT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $92,973 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,237 | | Amount paid for insurance broker fees | 4517 | | Additional information about fees paid to insurance broker | CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $35,545 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $723,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,545 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,071 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,071 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,626 | | Total amount of fees paid to insurance company | USD $5,560 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT LIFE, VOL CRT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $103,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,626 | | Amount paid for insurance broker fees | 5560 | | Additional information about fees paid to insurance broker | CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $39,220 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $691,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,220 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $950 | | Total amount of fees paid to insurance company | USD $84 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $950 | | Amount paid for insurance broker fees | 39 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS/BONUSES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $12,808 | | Total amount of fees paid to insurance company | USD $4,821 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT LIFE, VOL CRT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $107,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,808 | | Amount paid for insurance broker fees | 4821 | | Additional information about fees paid to insurance broker | COMMISSIONS/FEES | | Insurance broker organization code? | 3 |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $30,678 | | Total amount of fees paid to insurance company | USD $4,112 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $619,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,678 | | Amount paid for insurance broker fees | 4059 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS/BONUSES | | Insurance broker organization code? | 3 |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $23,351 | | Total amount of fees paid to insurance company | USD $2,686 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $523,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,351 | | Amount paid for insurance broker fees | 2686 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS/BONUSES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $8,800 | | Total amount of fees paid to insurance company | USD $3,689 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT LIFE, VOL CRT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $79,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,800 | | Amount paid for insurance broker fees | 3689 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 689037 |
| Policy instance | 3 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $700 | | Total amount of fees paid to insurance company | USD $44 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,830 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $700 | | Amount paid for insurance broker fees | 44 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS/BONUSES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00325881 |
| Policy instance | 2 |
| Insurance contract or identification number | 00325881 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $7,121 | | Total amount of fees paid to insurance company | USD $4,152 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $78,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,121 | | Amount paid for insurance broker fees | 4152 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE, LLC |
|
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 689037 |
| Policy instance | 1 |
| Insurance contract or identification number | 689037 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $29,083 | | Total amount of fees paid to insurance company | USD $1,849 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $540,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,083 | | Amount paid for insurance broker fees | 1849 | | Additional information about fees paid to insurance broker | OTHER COMMISSIONS/BONUSES | | Insurance broker organization code? | 3 | | Insurance broker name | WLA INSURANCE, LLC |
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