CITY GEAR, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CITY GEAR, LLC WELFARE BENEFIT PLAN
| Measure | Date | Value |
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| 2017: CITY GEAR, LLC WELFARE BENEFIT PLAN 2017 401k membership |
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| Total participants, beginning-of-year | 2017-08-01 | 287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 275 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
| Total of all active and inactive participants | 2017-08-01 | 275 |
| 2016: CITY GEAR, LLC WELFARE BENEFIT PLAN 2016 401k membership |
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| Total participants, beginning-of-year | 2016-08-01 | 287 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 279 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
| Total of all active and inactive participants | 2016-08-01 | 279 |
| 2015: CITY GEAR, LLC WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 202 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 287 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
| Total of all active and inactive participants | 2015-08-01 | 287 |
| 2014: CITY GEAR, LLC WELFARE BENEFIT PLAN 2014 401k membership |
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| Total participants, beginning-of-year | 2014-08-01 | 184 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 202 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
| Total of all active and inactive participants | 2014-08-01 | 202 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 00911611 |
| Policy instance | 4 |
| Insurance contract or identification number | 00911611 | | Number of Individuals Covered | 379 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $9,705 | | Total amount of fees paid to insurance company | USD $71,984 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,428,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,705 | | Amount paid for insurance broker fees | 71984 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT AND BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC. |
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| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00616086 |
| Policy instance | 3 |
| Insurance contract or identification number | G 00616086 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $17,785 | | Total amount of fees paid to insurance company | USD $8,063 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 $118,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,785 | | Amount paid for insurance broker fees | 8063 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | REGIONS INSURANCE INC. |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4861928 |
| Policy instance | 2 |
| Insurance contract or identification number | E4861928 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-30 | | Total amount of commissions paid to insurance broker | USD $33,981 | | Total amount of fees paid to insurance company | USD $10,800 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT AND CRITICAL CARE | | 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 $58,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,687 | | Amount paid for insurance broker fees | 241 | | Additional information about fees paid to insurance broker | FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | GREG GRIFFITH |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 12183 |
| Policy instance | 1 |
| Insurance contract or identification number | 12183 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-30 | | Total amount of commissions paid to insurance broker | USD $6,728 | | Total amount of fees paid to insurance company | USD $2,804 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 $56,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,607 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2804 | | Additional information about fees paid to insurance broker | EXPENSE ALLOWANCE | | Insurance broker name | GROUP INSURANCE SERVICES INC. |
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| UNITED DENTAL CARE OF MISSOURI, INC. (National Association of Insurance Commissioners NAIC id number: 47044 ) |
| Policy contract number | 5468248 |
| Policy instance | 7 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $105 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $105 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UDC OF OHIO, INC. (National Association of Insurance Commissioners NAIC id number: 52022 ) |
| Policy contract number | 5468248 |
| Policy instance | 6 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| DENTICARE OF ALABAMA, INC. (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468248 |
| Policy instance | 5 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $61 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468248 |
| Policy instance | 4 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $13,919 | | Total amount of fees paid to insurance company | USD $141 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $121,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,919 | | Amount paid for insurance broker fees | 40 | | Additional information about fees paid to insurance broker | MARKETING FEE | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 755233 |
| Policy instance | 3 |
| Insurance contract or identification number | 755233 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $58,283 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,051,392 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 55283 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 4999034 |
| Policy instance | 2 |
| Insurance contract or identification number | 4999034 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-30 | | Total amount of commissions paid to insurance broker | USD $10,011 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $38,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,011 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 4999402 |
| Policy instance | 1 |
| Insurance contract or identification number | 4999402 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2016-07-30 | | Total amount of commissions paid to insurance broker | USD $3,064 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,064 | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNITED DENTAL CARE OF MISSOURI, INC. (National Association of Insurance Commissioners NAIC id number: 47044 ) |
| Policy contract number | 5468248 |
| Policy instance | 8 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $134 | | Total amount of fees paid to insurance company | USD $11 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $134 | | Amount paid for insurance broker fees | 11 | | Additional information about fees paid to insurance broker | PRODUCER BONUS PROGRAM PAYMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UDC OF OHIO, INC. (National Association of Insurance Commissioners NAIC id number: 52022 ) |
| Policy contract number | 5468248 |
| Policy instance | 7 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $25 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 25 | | Additional information about fees paid to insurance broker | PRODUCER PROGRAM BONUS PAYMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 ) |
| Policy contract number | 5468248 |
| Policy instance | 6 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $23 | | Total amount of fees paid to insurance company | USD $3 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $139 | | 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 | | Amount paid for insurance broker fees | 3 | | Additional information about fees paid to insurance broker | PRODCUER BONUS PROGRAM PAYMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| DENTICARE OF ALABAMA, INC. (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468248 |
| Policy instance | 5 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $84 | | Total amount of fees paid to insurance company | USD $33 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $84 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | PRODUCER BONUS PROGRAM PAYMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5468248 |
| Policy instance | 4 |
| Insurance contract or identification number | 5468248 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $11,176 | | Total amount of fees paid to insurance company | USD $4,531 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $96,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,176 | | Amount paid for insurance broker fees | 141 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 755233 |
| Policy instance | 3 |
| Insurance contract or identification number | 755233 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $57,707 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,134,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 54707 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 4999034 |
| Policy instance | 2 |
| Insurance contract or identification number | 4999034 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-30 | | Total amount of commissions paid to insurance broker | USD $13,792 | | Total amount of fees paid to insurance company | USD $2,243 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ACCIDENT INSURANCE | | Welfare Benefit Premiums Paid to Carrier | USD $37,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,792 | | Amount paid for insurance broker fees | 52 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 4999402 |
| Policy instance | 1 |
| Insurance contract or identification number | 4999402 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-30 | | Total amount of commissions paid to insurance broker | USD $5,496 | | Total amount of fees paid to insurance company | USD $844 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,496 | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | JAS D COLLIER & COMPANY INSURANCE |
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