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RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 401k Plan overview

Plan NameRED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST
Plan identification number 501

RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

RED BALL OXYGEN COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:RED BALL OXYGEN COMPANY, INC.
Employer identification number (EIN):720683236
NAIC Classification:325100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-08-01
5012021-08-01
5012020-08-01
5012019-08-01
5012018-08-01
5012017-08-01RALPH THOMAS
5012016-08-01RALPH THOMAS
5012015-08-01RALPH THOMAS
5012014-08-01RALPH THOMAS
5012013-08-01RALPH THOMAS RALPH THOMAS2015-05-08
5012012-08-01RALPH THOMAS
5012011-08-01RALPH THOMAS RALPH THOMAS2013-10-14
5012010-08-01RALPH THOMAS RALPH THOMAS2012-05-12
5012009-08-01RALPH THOMAS RALPH THOMAS2011-05-13

Plan Statistics for RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST

401k plan membership statisitcs for RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST

Measure Date Value
2022: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2022 401k membership
Total participants, beginning-of-year2022-08-01188
Total number of active participants reported on line 7a of the Form 55002022-08-01201
Number of retired or separated participants receiving benefits2022-08-012
Total of all active and inactive participants2022-08-01203
Total participants2022-08-01203
2021: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2021 401k membership
Total participants, beginning-of-year2021-08-01193
Total number of active participants reported on line 7a of the Form 55002021-08-01187
Number of retired or separated participants receiving benefits2021-08-010
Total of all active and inactive participants2021-08-01187
Total participants2021-08-01187
2020: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2020 401k membership
Total participants, beginning-of-year2020-08-01212
Total number of active participants reported on line 7a of the Form 55002020-08-01191
Number of retired or separated participants receiving benefits2020-08-012
Total of all active and inactive participants2020-08-01193
Total participants2020-08-01193
2019: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2019 401k membership
Total participants, beginning-of-year2019-08-01211
Total number of active participants reported on line 7a of the Form 55002019-08-01210
Number of retired or separated participants receiving benefits2019-08-012
Total of all active and inactive participants2019-08-01212
Total participants2019-08-01212
2018: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2018 401k membership
Total participants, beginning-of-year2018-08-01198
Total number of active participants reported on line 7a of the Form 55002018-08-01209
Number of retired or separated participants receiving benefits2018-08-012
Total of all active and inactive participants2018-08-01211
Total participants2018-08-01211
2017: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2017 401k membership
Total participants, beginning-of-year2017-08-01169
Total number of active participants reported on line 7a of the Form 55002017-08-01194
Number of retired or separated participants receiving benefits2017-08-014
Total of all active and inactive participants2017-08-01198
Total participants2017-08-01198
2016: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2016 401k membership
Total participants, beginning-of-year2016-08-01171
Total number of active participants reported on line 7a of the Form 55002016-08-01167
Number of retired or separated participants receiving benefits2016-08-012
Total of all active and inactive participants2016-08-01169
Total participants2016-08-01169
2015: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year2015-08-01172
Total number of active participants reported on line 7a of the Form 55002015-08-01168
Number of retired or separated participants receiving benefits2015-08-013
Total of all active and inactive participants2015-08-01171
Total participants2015-08-01171
2014: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2014 401k membership
Total participants, beginning-of-year2014-08-01173
Total number of active participants reported on line 7a of the Form 55002014-08-01170
Number of retired or separated participants receiving benefits2014-08-012
Total of all active and inactive participants2014-08-01172
Total participants2014-08-01172
2013: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2013 401k membership
Total participants, beginning-of-year2013-08-01174
Total number of active participants reported on line 7a of the Form 55002013-08-01171
Number of retired or separated participants receiving benefits2013-08-012
Total of all active and inactive participants2013-08-01173
Total participants2013-08-01173
2012: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year2012-08-01176
Total number of active participants reported on line 7a of the Form 55002012-08-01174
Number of retired or separated participants receiving benefits2012-08-010
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01174
2011: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year2011-08-01142
Total number of active participants reported on line 7a of the Form 55002011-08-01176
Number of retired or separated participants receiving benefits2011-08-010
Number of other retired or separated participants entitled to future benefits2011-08-010
Total of all active and inactive participants2011-08-01176
2010: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year2010-08-01147
Total number of active participants reported on line 7a of the Form 55002010-08-01142
Number of retired or separated participants receiving benefits2010-08-010
Number of other retired or separated participants entitled to future benefits2010-08-010
Total of all active and inactive participants2010-08-01142
Total participants2010-08-01142
2009: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year2009-08-01140
Total number of active participants reported on line 7a of the Form 55002009-08-01147
Number of retired or separated participants receiving benefits2009-08-010
Number of other retired or separated participants entitled to future benefits2009-08-010
Total of all active and inactive participants2009-08-01147

Financial Data on RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST

Measure Date Value
2023 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-07-31$242,955
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-07-31$209,693
Total income from all sources (including contributions)2023-07-31$2,833,536
Total loss/gain on sale of assets2023-07-31$0
Total of all expenses incurred2023-07-31$2,828,479
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-07-31$2,651,896
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-07-31$2,833,536
Value of total assets at end of year2023-07-31$151,786
Value of total assets at beginning of year2023-07-31$113,467
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-07-31$176,583
Total interest from all sources2023-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-07-31$0
Was this plan covered by a fidelity bond2023-07-31Yes
Value of fidelity bond cover2023-07-31$500,000
If this is an individual account plan, was there a blackout period2023-07-31No
Were there any nonexempt tranactions with any party-in-interest2023-07-31No
Contributions received from participants2023-07-31$557,486
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-07-31$136,076
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-07-31$75,882
Total non interest bearing cash at end of year2023-07-31$15,710
Total non interest bearing cash at beginning of year2023-07-31$37,585
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-07-31No
Value of net income/loss2023-07-31$5,057
Value of net assets at end of year (total assets less liabilities)2023-07-31$-91,169
Value of net assets at beginning of year (total assets less liabilities)2023-07-31$-96,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-07-31No
Were any leases to which the plan was party in default or uncollectible2023-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2023-07-31$671,898
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-07-31No
Was there a failure to transmit to the plan any participant contributions2023-07-31No
Has the plan failed to provide any benefit when due under the plan2023-07-31No
Contributions received in cash from employer2023-07-31$2,276,050
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-07-31$1,979,998
Contract administrator fees2023-07-31$176,583
Liabilities. Value of benefit claims payable at end of year2023-07-31$242,955
Liabilities. Value of benefit claims payable at beginning of year2023-07-31$209,693
Did the plan have assets held for investment2023-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-07-31No
Opinion of an independent qualified public accountant for this plan2023-07-31Unqualified
Accountancy firm name2023-07-31EISNERAMPER LLP
Accountancy firm EIN2023-07-31871363769
2022 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-07-31$165,371
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-07-31$169,508
Total income from all sources (including contributions)2022-07-31$2,662,747
Total loss/gain on sale of assets2022-07-31$0
Total of all expenses incurred2022-07-31$2,751,008
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-07-31$2,170,420
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-07-31$2,662,747
Value of total assets at end of year2022-07-31$70,045
Value of total assets at beginning of year2022-07-31$162,443
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-07-31$580,588
Total interest from all sources2022-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-07-31$0
Administrative expenses professional fees incurred2022-07-31$12
Was this plan covered by a fidelity bond2022-07-31Yes
Value of fidelity bond cover2022-07-31$500,000
If this is an individual account plan, was there a blackout period2022-07-31No
Were there any nonexempt tranactions with any party-in-interest2022-07-31No
Contributions received from participants2022-07-31$547,739
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-07-31$32,460
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-07-31$133,383
Total non interest bearing cash at end of year2022-07-31$37,585
Total non interest bearing cash at beginning of year2022-07-31$29,060
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Value of net income/loss2022-07-31$-88,261
Value of net assets at end of year (total assets less liabilities)2022-07-31$-95,326
Value of net assets at beginning of year (total assets less liabilities)2022-07-31$-7,065
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-07-31No
Were any leases to which the plan was party in default or uncollectible2022-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-07-31$148,157
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-07-31No
Was there a failure to transmit to the plan any participant contributions2022-07-31No
Has the plan failed to provide any benefit when due under the plan2022-07-31No
Contributions received in cash from employer2022-07-31$2,115,008
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-07-31$2,022,263
Contract administrator fees2022-07-31$580,576
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-07-31No
Liabilities. Value of benefit claims payable at end of year2022-07-31$165,371
Liabilities. Value of benefit claims payable at beginning of year2022-07-31$169,508
Did the plan have assets held for investment2022-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-07-31No
Opinion of an independent qualified public accountant for this plan2022-07-31Unqualified
Accountancy firm name2022-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2022-07-31752593210
2021 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-31$169,508
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-31$184,208
Total income from all sources (including contributions)2021-07-31$2,227,603
Total loss/gain on sale of assets2021-07-31$0
Total of all expenses incurred2021-07-31$2,542,993
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-07-31$1,782,726
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-07-31$2,227,603
Value of total assets at end of year2021-07-31$162,443
Value of total assets at beginning of year2021-07-31$492,533
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-07-31$760,267
Total interest from all sources2021-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-07-31$0
Administrative expenses professional fees incurred2021-07-31$14,750
Was this plan covered by a fidelity bond2021-07-31Yes
Value of fidelity bond cover2021-07-31$500,000
If this is an individual account plan, was there a blackout period2021-07-31No
Were there any nonexempt tranactions with any party-in-interest2021-07-31No
Contributions received from participants2021-07-31$577,989
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-07-31$133,383
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-07-31$4,441
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-07-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-07-31$8,869
Total non interest bearing cash at end of year2021-07-31$29,060
Total non interest bearing cash at beginning of year2021-07-31$488,092
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-31No
Value of net income/loss2021-07-31$-315,390
Value of net assets at end of year (total assets less liabilities)2021-07-31$-7,065
Value of net assets at beginning of year (total assets less liabilities)2021-07-31$308,325
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-07-31No
Were any leases to which the plan was party in default or uncollectible2021-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-07-31$126,405
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-07-31No
Was there a failure to transmit to the plan any participant contributions2021-07-31No
Has the plan failed to provide any benefit when due under the plan2021-07-31No
Contributions received in cash from employer2021-07-31$1,649,614
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-07-31$1,656,321
Contract administrator fees2021-07-31$745,517
Liabilities. Value of benefit claims payable at end of year2021-07-31$169,508
Liabilities. Value of benefit claims payable at beginning of year2021-07-31$175,339
Did the plan have assets held for investment2021-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-07-31No
Opinion of an independent qualified public accountant for this plan2021-07-31Unqualified
Accountancy firm name2021-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2021-07-31752593210
2020 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-07-31$184,208
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-07-31$112,247
Total income from all sources (including contributions)2020-07-31$2,617,437
Total loss/gain on sale of assets2020-07-31$0
Total of all expenses incurred2020-07-31$2,245,422
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-07-31$1,668,849
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-07-31$2,617,437
Value of total assets at end of year2020-07-31$492,533
Value of total assets at beginning of year2020-07-31$48,557
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-07-31$576,573
Total interest from all sources2020-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-07-31$0
Administrative expenses professional fees incurred2020-07-31$14,500
Was this plan covered by a fidelity bond2020-07-31Yes
Value of fidelity bond cover2020-07-31$500,000
If this is an individual account plan, was there a blackout period2020-07-31No
Were there any nonexempt tranactions with any party-in-interest2020-07-31No
Contributions received from participants2020-07-31$501,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-07-31$4,441
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-07-31$8,102
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-07-31$8,869
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-07-31$19,688
Total non interest bearing cash at end of year2020-07-31$488,092
Total non interest bearing cash at beginning of year2020-07-31$40,455
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-07-31No
Value of net income/loss2020-07-31$372,015
Value of net assets at end of year (total assets less liabilities)2020-07-31$308,325
Value of net assets at beginning of year (total assets less liabilities)2020-07-31$-63,690
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-07-31No
Were any leases to which the plan was party in default or uncollectible2020-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-07-31$133,982
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-07-31No
Was there a failure to transmit to the plan any participant contributions2020-07-31No
Has the plan failed to provide any benefit when due under the plan2020-07-31No
Contributions received in cash from employer2020-07-31$2,116,437
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-07-31$1,534,867
Contract administrator fees2020-07-31$562,073
Liabilities. Value of benefit claims payable at end of year2020-07-31$175,339
Liabilities. Value of benefit claims payable at beginning of year2020-07-31$92,559
Did the plan have assets held for investment2020-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-07-31No
Opinion of an independent qualified public accountant for this plan2020-07-31Unqualified
Accountancy firm name2020-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2020-07-31752593210
2019 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-07-31$112,247
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-07-31$200,713
Total income from all sources (including contributions)2019-07-31$2,224,190
Total loss/gain on sale of assets2019-07-31$0
Total of all expenses incurred2019-07-31$2,512,077
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-07-31$1,781,881
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-07-31$2,224,190
Value of total assets at end of year2019-07-31$48,557
Value of total assets at beginning of year2019-07-31$424,910
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-07-31$730,196
Total interest from all sources2019-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-07-31$0
Administrative expenses professional fees incurred2019-07-31$14,298
Was this plan covered by a fidelity bond2019-07-31Yes
Value of fidelity bond cover2019-07-31$500,000
If this is an individual account plan, was there a blackout period2019-07-31No
Were there any nonexempt tranactions with any party-in-interest2019-07-31No
Contributions received from participants2019-07-31$408,810
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-07-31$8,102
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-07-31$4,076
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-07-31$19,688
Total non interest bearing cash at end of year2019-07-31$40,455
Total non interest bearing cash at beginning of year2019-07-31$420,834
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-07-31No
Value of net income/loss2019-07-31$-287,887
Value of net assets at end of year (total assets less liabilities)2019-07-31$-63,690
Value of net assets at beginning of year (total assets less liabilities)2019-07-31$224,197
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-07-31No
Were any leases to which the plan was party in default or uncollectible2019-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-07-31$119,597
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-07-31No
Was there a failure to transmit to the plan any participant contributions2019-07-31No
Has the plan failed to provide any benefit when due under the plan2019-07-31No
Contributions received in cash from employer2019-07-31$1,815,380
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-07-31$1,662,284
Contract administrator fees2019-07-31$715,898
Liabilities. Value of benefit claims payable at end of year2019-07-31$92,559
Liabilities. Value of benefit claims payable at beginning of year2019-07-31$200,713
Did the plan have assets held for investment2019-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-07-31No
Opinion of an independent qualified public accountant for this plan2019-07-31Unqualified
Accountancy firm name2019-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2019-07-31752593210
2018 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-07-31$200,713
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-07-31$110,550
Total income from all sources (including contributions)2018-07-31$1,710,470
Total loss/gain on sale of assets2018-07-31$0
Total of all expenses incurred2018-07-31$1,900,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-07-31$1,392,382
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-07-31$1,710,470
Value of total assets at end of year2018-07-31$424,910
Value of total assets at beginning of year2018-07-31$524,585
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-07-31$507,926
Total interest from all sources2018-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-07-31$0
Administrative expenses professional fees incurred2018-07-31$13,900
Was this plan covered by a fidelity bond2018-07-31Yes
Value of fidelity bond cover2018-07-31$500,000
If this is an individual account plan, was there a blackout period2018-07-31No
Were there any nonexempt tranactions with any party-in-interest2018-07-31No
Contributions received from participants2018-07-31$347,970
Participant contributions at beginning of year2018-07-31$9,744
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-07-31$4,076
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-07-31$64,698
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-07-31$2,000
Total non interest bearing cash at end of year2018-07-31$420,834
Total non interest bearing cash at beginning of year2018-07-31$450,143
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-07-31No
Value of net income/loss2018-07-31$-189,838
Value of net assets at end of year (total assets less liabilities)2018-07-31$224,197
Value of net assets at beginning of year (total assets less liabilities)2018-07-31$414,035
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-07-31No
Were any leases to which the plan was party in default or uncollectible2018-07-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-07-31$89,038
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-07-31No
Was there a failure to transmit to the plan any participant contributions2018-07-31No
Has the plan failed to provide any benefit when due under the plan2018-07-31No
Contributions received in cash from employer2018-07-31$1,362,500
Employer contributions (assets) at end of year2018-07-31$0
Employer contributions (assets) at beginning of year2018-07-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-07-31$1,303,344
Contract administrator fees2018-07-31$494,026
Liabilities. Value of benefit claims payable at end of year2018-07-31$200,713
Liabilities. Value of benefit claims payable at beginning of year2018-07-31$108,550
Did the plan have assets held for investment2018-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-07-31No
Opinion of an independent qualified public accountant for this plan2018-07-31Unqualified
Accountancy firm name2018-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2018-07-31752593210
2017 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-07-31$110,550
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-07-31$213,400
Total income from all sources (including contributions)2017-07-31$1,858,865
Total loss/gain on sale of assets2017-07-31$0
Total of all expenses incurred2017-07-31$1,766,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-07-31$1,295,591
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-07-31$1,858,865
Value of total assets at end of year2017-07-31$524,585
Value of total assets at beginning of year2017-07-31$534,882
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-07-31$470,721
Total interest from all sources2017-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-07-31$0
Administrative expenses professional fees incurred2017-07-31$13,500
Was this plan covered by a fidelity bond2017-07-31Yes
Value of fidelity bond cover2017-07-31$500,000
If this is an individual account plan, was there a blackout period2017-07-31No
Were there any nonexempt tranactions with any party-in-interest2017-07-31No
Contributions received from participants2017-07-31$334,152
Participant contributions at end of year2017-07-31$9,744
Assets. Other investments not covered elsewhere at end of year2017-07-31$0
Assets. Other investments not covered elsewhere at beginning of year2017-07-31$3,982
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-07-31$64,698
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-07-31$34,246
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-07-31$2,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-07-31$0
Total non interest bearing cash at end of year2017-07-31$450,143
Total non interest bearing cash at beginning of year2017-07-31$371,654
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-31No
Value of net income/loss2017-07-31$92,553
Value of net assets at end of year (total assets less liabilities)2017-07-31$414,035
Value of net assets at beginning of year (total assets less liabilities)2017-07-31$321,482
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-07-31No
Were any leases to which the plan was party in default or uncollectible2017-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-07-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-07-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-07-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-07-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2017-07-31$113,593
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-07-31No
Was there a failure to transmit to the plan any participant contributions2017-07-31No
Has the plan failed to provide any benefit when due under the plan2017-07-31No
Contributions received in cash from employer2017-07-31$1,524,713
Employer contributions (assets) at end of year2017-07-31$0
Employer contributions (assets) at beginning of year2017-07-31$125,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-07-31$1,181,998
Contract administrator fees2017-07-31$457,221
Liabilities. Value of benefit claims payable at end of year2017-07-31$108,550
Liabilities. Value of benefit claims payable at beginning of year2017-07-31$213,400
Did the plan have assets held for investment2017-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-07-31No
Opinion of an independent qualified public accountant for this plan2017-07-31Unqualified
Accountancy firm name2017-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2017-07-31752593210
2016 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-07-31$213,400
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-07-31$171,029
Total income from all sources (including contributions)2016-07-31$1,683,932
Total loss/gain on sale of assets2016-07-31$0
Total of all expenses incurred2016-07-31$1,723,479
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-07-31$1,271,155
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-07-31$1,681,566
Value of total assets at end of year2016-07-31$534,882
Value of total assets at beginning of year2016-07-31$532,058
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-07-31$452,324
Total interest from all sources2016-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-07-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-07-31No
Administrative expenses professional fees incurred2016-07-31$13,500
Was this plan covered by a fidelity bond2016-07-31Yes
Value of fidelity bond cover2016-07-31$500,000
If this is an individual account plan, was there a blackout period2016-07-31No
Were there any nonexempt tranactions with any party-in-interest2016-07-31No
Contributions received from participants2016-07-31$354,066
Assets. Other investments not covered elsewhere at end of year2016-07-31$3,982
Assets. Other investments not covered elsewhere at beginning of year2016-07-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-07-31$34,246
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-07-31$40,758
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-07-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-07-31$2,000
Other income not declared elsewhere2016-07-31$2,366
Total non interest bearing cash at end of year2016-07-31$371,654
Total non interest bearing cash at beginning of year2016-07-31$491,300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-07-31No
Value of net income/loss2016-07-31$-39,547
Value of net assets at end of year (total assets less liabilities)2016-07-31$321,482
Value of net assets at beginning of year (total assets less liabilities)2016-07-31$361,029
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-07-31No
Were any leases to which the plan was party in default or uncollectible2016-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-07-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-07-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-07-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-07-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2016-07-31$96,370
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-07-31No
Was there a failure to transmit to the plan any participant contributions2016-07-31No
Has the plan failed to provide any benefit when due under the plan2016-07-31No
Contributions received in cash from employer2016-07-31$1,327,500
Employer contributions (assets) at end of year2016-07-31$125,000
Employer contributions (assets) at beginning of year2016-07-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-07-31$1,174,785
Contract administrator fees2016-07-31$438,824
Liabilities. Value of benefit claims payable at end of year2016-07-31$213,400
Liabilities. Value of benefit claims payable at beginning of year2016-07-31$169,029
Did the plan have assets held for investment2016-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-07-31No
Opinion of an independent qualified public accountant for this plan2016-07-31Unqualified
Accountancy firm name2016-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2016-07-31752593210
2015 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-07-31$171,029
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-07-31$50,431
Total income from all sources (including contributions)2015-07-31$1,989,936
Total loss/gain on sale of assets2015-07-31$0
Total of all expenses incurred2015-07-31$1,822,438
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-07-31$1,250,915
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-07-31$1,979,601
Value of total assets at end of year2015-07-31$532,058
Value of total assets at beginning of year2015-07-31$243,962
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-07-31$571,523
Total interest from all sources2015-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-07-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-07-31No
Administrative expenses professional fees incurred2015-07-31$14,778
Was this plan covered by a fidelity bond2015-07-31Yes
Value of fidelity bond cover2015-07-31$500,000
If this is an individual account plan, was there a blackout period2015-07-31No
Were there any nonexempt tranactions with any party-in-interest2015-07-31No
Contributions received from participants2015-07-31$433,600
Assets. Other investments not covered elsewhere at end of year2015-07-31$0
Assets. Other investments not covered elsewhere at beginning of year2015-07-31$3,823
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-07-31$40,758
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-07-31$126,761
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-07-31$2,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-07-31$24,165
Other income not declared elsewhere2015-07-31$10,335
Liabilities. Value of operating payables at end of year2015-07-31$0
Liabilities. Value of operating payables at beginning of year2015-07-31$0
Total non interest bearing cash at end of year2015-07-31$491,300
Total non interest bearing cash at beginning of year2015-07-31$113,378
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-07-31No
Value of net income/loss2015-07-31$167,498
Value of net assets at end of year (total assets less liabilities)2015-07-31$361,029
Value of net assets at beginning of year (total assets less liabilities)2015-07-31$193,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-07-31No
Were any leases to which the plan was party in default or uncollectible2015-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-07-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-07-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-07-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-07-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2015-07-31$121,831
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-07-31No
Was there a failure to transmit to the plan any participant contributions2015-07-31No
Has the plan failed to provide any benefit when due under the plan2015-07-31No
Contributions received in cash from employer2015-07-31$1,546,001
Employer contributions (assets) at end of year2015-07-31$0
Employer contributions (assets) at beginning of year2015-07-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-07-31$1,129,084
Contract administrator fees2015-07-31$556,745
Liabilities. Value of benefit claims payable at end of year2015-07-31$169,029
Liabilities. Value of benefit claims payable at beginning of year2015-07-31$26,266
Did the plan have assets held for investment2015-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-07-31No
Opinion of an independent qualified public accountant for this plan2015-07-31Unqualified
Accountancy firm name2015-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2015-07-31752593210
2014 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-07-31$50,431
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-07-31$108,259
Total income from all sources (including contributions)2014-07-31$2,274,814
Total loss/gain on sale of assets2014-07-31$0
Total of all expenses incurred2014-07-31$2,192,186
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-07-31$1,642,965
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-07-31$2,262,958
Value of total assets at end of year2014-07-31$243,962
Value of total assets at beginning of year2014-07-31$219,162
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-07-31$549,221
Total interest from all sources2014-07-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-07-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-07-31No
Administrative expenses professional fees incurred2014-07-31$8,500
Was this plan covered by a fidelity bond2014-07-31Yes
Value of fidelity bond cover2014-07-31$500,000
If this is an individual account plan, was there a blackout period2014-07-31No
Were there any nonexempt tranactions with any party-in-interest2014-07-31No
Contributions received from participants2014-07-31$351,364
Assets. Other investments not covered elsewhere at end of year2014-07-31$3,823
Assets. Other investments not covered elsewhere at beginning of year2014-07-31$42,818
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-07-31$126,761
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-07-31$47,883
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-07-31$24,165
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-07-31$0
Other income not declared elsewhere2014-07-31$11,856
Liabilities. Value of operating payables at end of year2014-07-31$0
Liabilities. Value of operating payables at beginning of year2014-07-31$0
Total non interest bearing cash at end of year2014-07-31$113,378
Total non interest bearing cash at beginning of year2014-07-31$895
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-07-31No
Value of net income/loss2014-07-31$82,628
Value of net assets at end of year (total assets less liabilities)2014-07-31$193,531
Value of net assets at beginning of year (total assets less liabilities)2014-07-31$110,903
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-07-31No
Were any leases to which the plan was party in default or uncollectible2014-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-07-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-07-31$127,566
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-07-31$127,566
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-07-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-07-31$65,264
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-07-31No
Was there a failure to transmit to the plan any participant contributions2014-07-31No
Has the plan failed to provide any benefit when due under the plan2014-07-31No
Contributions received in cash from employer2014-07-31$1,911,594
Employer contributions (assets) at end of year2014-07-31$0
Employer contributions (assets) at beginning of year2014-07-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-07-31$1,577,701
Contract administrator fees2014-07-31$540,721
Liabilities. Value of benefit claims payable at end of year2014-07-31$26,266
Liabilities. Value of benefit claims payable at beginning of year2014-07-31$108,259
Did the plan have assets held for investment2014-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-07-31No
Opinion of an independent qualified public accountant for this plan2014-07-31Unqualified
Accountancy firm name2014-07-31SUTTON FROST CARY LLP
Accountancy firm EIN2014-07-31752593210
2013 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-07-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-07-31$108,259
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-07-31$27,214
Total income from all sources (including contributions)2013-07-31$1,668,527
Total loss/gain on sale of assets2013-07-31$0
Total of all expenses incurred2013-07-31$1,558,057
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-07-31$965,932
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-07-31$1,658,087
Value of total assets at end of year2013-07-31$219,162
Value of total assets at beginning of year2013-07-31$27,647
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-07-31$592,125
Total interest from all sources2013-07-31$436
Total dividends received (eg from common stock, registered investment company shares)2013-07-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-07-31No
Administrative expenses professional fees incurred2013-07-31$8,117
Was this plan covered by a fidelity bond2013-07-31Yes
Value of fidelity bond cover2013-07-31$500,000
If this is an individual account plan, was there a blackout period2013-07-31No
Were there any nonexempt tranactions with any party-in-interest2013-07-31No
Contributions received from participants2013-07-31$314,234
Assets. Other investments not covered elsewhere at end of year2013-07-31$42,818
Assets. Other investments not covered elsewhere at beginning of year2013-07-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-07-31$47,883
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-07-31$3,593
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-07-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-07-31$6,315
Other income not declared elsewhere2013-07-31$10,004
Liabilities. Value of operating payables at end of year2013-07-31$0
Liabilities. Value of operating payables at beginning of year2013-07-31$2,321
Total non interest bearing cash at end of year2013-07-31$895
Total non interest bearing cash at beginning of year2013-07-31$2,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-07-31No
Value of net income/loss2013-07-31$110,470
Value of net assets at end of year (total assets less liabilities)2013-07-31$110,903
Value of net assets at beginning of year (total assets less liabilities)2013-07-31$433
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-07-31No
Were any leases to which the plan was party in default or uncollectible2013-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-07-31$127,566
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-07-31$6,824
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-07-31$6,824
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-07-31$436
Expenses. Payments to insurance carriers foe the provision of benefits2013-07-31$39,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-07-31No
Was there a failure to transmit to the plan any participant contributions2013-07-31No
Has the plan failed to provide any benefit when due under the plan2013-07-31No
Contributions received in cash from employer2013-07-31$1,343,853
Employer contributions (assets) at end of year2013-07-31$0
Employer contributions (assets) at beginning of year2013-07-31$15,230
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-07-31$926,442
Contract administrator fees2013-07-31$584,008
Liabilities. Value of benefit claims payable at end of year2013-07-31$108,259
Liabilities. Value of benefit claims payable at beginning of year2013-07-31$18,578
Did the plan have assets held for investment2013-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-07-31No
Opinion of an independent qualified public accountant for this plan2013-07-31Unqualified
Accountancy firm name2013-07-31HARTMAN LEITO & BOLT, LLP
Accountancy firm EIN2013-07-31752407989
2012 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-07-31$27,214
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-07-31$7,294
Total income from all sources (including contributions)2012-07-31$1,397,804
Total of all expenses incurred2012-07-31$1,406,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-07-31$1,395,395
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-07-31$1,394,157
Value of total assets at end of year2012-07-31$27,647
Value of total assets at beginning of year2012-07-31$16,846
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-07-31$11,528
Total interest from all sources2012-07-31$54
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-07-31No
Was this plan covered by a fidelity bond2012-07-31Yes
Value of fidelity bond cover2012-07-31$500,000
If this is an individual account plan, was there a blackout period2012-07-31No
Were there any nonexempt tranactions with any party-in-interest2012-07-31No
Contributions received from participants2012-07-31$286,932
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-07-31$3,593
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-07-31$9,254
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-07-31$6,315
Other income not declared elsewhere2012-07-31$3,593
Administrative expenses (other) incurred2012-07-31$46
Liabilities. Value of operating payables at end of year2012-07-31$2,321
Total non interest bearing cash at end of year2012-07-31$2,000
Total non interest bearing cash at beginning of year2012-07-31$147
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-07-31No
Value of net income/loss2012-07-31$-9,119
Value of net assets at end of year (total assets less liabilities)2012-07-31$433
Value of net assets at beginning of year (total assets less liabilities)2012-07-31$9,552
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-07-31No
Were any leases to which the plan was party in default or uncollectible2012-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-07-31$6,824
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-07-31$7,445
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-07-31$7,445
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-07-31$54
Expenses. Payments to insurance carriers foe the provision of benefits2012-07-31$1,312,244
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-07-31No
Was there a failure to transmit to the plan any participant contributions2012-07-31No
Has the plan failed to provide any benefit when due under the plan2012-07-31No
Contributions received in cash from employer2012-07-31$1,107,225
Employer contributions (assets) at end of year2012-07-31$15,230
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-07-31$83,151
Contract administrator fees2012-07-31$11,482
Liabilities. Value of benefit claims payable at end of year2012-07-31$18,578
Liabilities. Value of benefit claims payable at beginning of year2012-07-31$7,294
Did the plan have assets held for investment2012-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-07-31No
Opinion of an independent qualified public accountant for this plan2012-07-31Unqualified
Accountancy firm name2012-07-31YOUNG & BELL, ACCPA
Accountancy firm EIN2012-07-31721061504
2011 : RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-07-31$7,294
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-07-31$122,970
Total income from all sources (including contributions)2011-07-31$828,259
Total of all expenses incurred2011-07-31$1,081,472
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-07-31$1,072,723
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-07-31$821,883
Value of total assets at end of year2011-07-31$16,846
Value of total assets at beginning of year2011-07-31$385,735
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-07-31$8,749
Total interest from all sources2011-07-31$1,552
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-07-31No
Was this plan covered by a fidelity bond2011-07-31Yes
Value of fidelity bond cover2011-07-31$500,000
If this is an individual account plan, was there a blackout period2011-07-31No
Were there any nonexempt tranactions with any party-in-interest2011-07-31No
Contributions received from participants2011-07-31$235,933
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-07-31$9,254
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-07-31$33,694
Other income not declared elsewhere2011-07-31$4,824
Liabilities. Value of operating payables at beginning of year2011-07-31$9,328
Total non interest bearing cash at end of year2011-07-31$147
Total non interest bearing cash at beginning of year2011-07-31$940
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-07-31No
Value of net income/loss2011-07-31$-253,213
Value of net assets at end of year (total assets less liabilities)2011-07-31$9,552
Value of net assets at beginning of year (total assets less liabilities)2011-07-31$262,765
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-07-31No
Were any leases to which the plan was party in default or uncollectible2011-07-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-07-31$7,445
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-07-31$351,101
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-07-31$351,101
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-07-31$1,552
Expenses. Payments to insurance carriers foe the provision of benefits2011-07-31$1,030,246
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-07-31No
Was there a failure to transmit to the plan any participant contributions2011-07-31No
Has the plan failed to provide any benefit when due under the plan2011-07-31No
Contributions received in cash from employer2011-07-31$585,950
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-07-31$42,477
Contract administrator fees2011-07-31$8,749
Liabilities. Value of benefit claims payable at end of year2011-07-31$7,294
Liabilities. Value of benefit claims payable at beginning of year2011-07-31$113,642
Did the plan have assets held for investment2011-07-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-07-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-07-31No
Opinion of an independent qualified public accountant for this plan2011-07-31Unqualified
Accountancy firm name2011-07-31YOUNG & BELL, ACCPA
Accountancy firm EIN2011-07-31721061504

Form 5500 Responses for RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST

2022: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Submission has been amendedNo
2022-08-01This submission is the final filingNo
2022-08-01This return/report is a short plan year return/report (less than 12 months)No
2022-08-01Plan is a collectively bargained planNo
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – TrustYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement - TrustYes
2021: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Submission has been amendedNo
2021-08-01This submission is the final filingNo
2021-08-01This return/report is a short plan year return/report (less than 12 months)No
2021-08-01Plan is a collectively bargained planNo
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan funding arrangement – TrustYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement - TrustYes
2020: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Submission has been amendedNo
2020-08-01This submission is the final filingNo
2020-08-01This return/report is a short plan year return/report (less than 12 months)No
2020-08-01Plan is a collectively bargained planNo
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan funding arrangement – TrustYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement - TrustYes
2019: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Submission has been amendedNo
2019-08-01This submission is the final filingNo
2019-08-01This return/report is a short plan year return/report (less than 12 months)No
2019-08-01Plan is a collectively bargained planNo
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan funding arrangement – TrustYes
2019-08-01Plan benefit arrangement – InsuranceYes
2019-08-01Plan benefit arrangement - TrustYes
2018: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Submission has been amendedNo
2018-08-01This submission is the final filingNo
2018-08-01This return/report is a short plan year return/report (less than 12 months)No
2018-08-01Plan is a collectively bargained planNo
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan funding arrangement – TrustYes
2018-08-01Plan benefit arrangement – InsuranceYes
2018-08-01Plan benefit arrangement - TrustYes
2017: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedNo
2017-08-01This submission is the final filingNo
2017-08-01This return/report is a short plan year return/report (less than 12 months)No
2017-08-01Plan is a collectively bargained planNo
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan funding arrangement – TrustYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement - TrustYes
2016: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – TrustYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement - TrustYes
2015: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan funding arrangement – TrustYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement - TrustYes
2014: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan funding arrangement – TrustYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement - TrustYes
2013: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan funding arrangement – TrustYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement - TrustYes
2012: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan funding arrangement – TrustYes
2012-08-01Plan benefit arrangement – InsuranceYes
2012-08-01Plan benefit arrangement - TrustYes
2011: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedYes
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan funding arrangement – TrustYes
2011-08-01Plan benefit arrangement – InsuranceYes
2011-08-01Plan benefit arrangement - TrustYes
2010: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan funding arrangement – TrustYes
2010-08-01Plan benefit arrangement – InsuranceYes
2010-08-01Plan benefit arrangement - TrustYes
2009: RED BALL COMPANIES EMPLOYEE MEDICAL BENEFIT TRUST 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan funding arrangement – TrustYes
2009-08-01Plan benefit arrangement – InsuranceYes
2009-08-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5385666
Policy instance 4
Insurance contract or identification number5385666
Number of Individuals Covered0
Insurance policy start date2023-07-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
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?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMCL21100167002
Policy instance 3
Insurance contract or identification numberEMCL21100167002
Number of Individuals Covered200
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $505,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B769
Policy instance 2
Insurance contract or identification numberG000B769
Number of Individuals Covered221
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $2,780
Total amount of fees paid to insurance companyUSD $3,372
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $39,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,780
Amount paid for insurance broker fees2248
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B769
Policy instance 1
Insurance contract or identification numberG000B769
Number of Individuals Covered221
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $4,228
Total amount of fees paid to insurance companyUSD $5,156
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $60,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,228
Amount paid for insurance broker fees3437
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B769
Policy instance 1
Insurance contract or identification numberG000B769
Number of Individuals Covered211
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $2,563
Total amount of fees paid to insurance companyUSD $1,958
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $36,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,563
Amount paid for insurance broker fees1958
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B769
Policy instance 2
Insurance contract or identification numberG000B769
Number of Individuals Covered211
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $3,893
Total amount of fees paid to insurance companyUSD $2,954
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $55,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,893
Amount paid for insurance broker fees2954
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L2110016700
Policy instance 3
Insurance contract or identification numberEMC L2110016700
Number of Individuals Covered191
Insurance policy start date2021-08-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $490,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0B769
Policy instance 3
Insurance contract or identification numberGLTD0B769
Number of Individuals Covered183
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $3,795
Total amount of fees paid to insurance companyUSD $2,722
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $54,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,795
Amount paid for insurance broker fees2722
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B769
Policy instance 2
Insurance contract or identification numberGUG0B769
Number of Individuals Covered183
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $2,516
Total amount of fees paid to insurance companyUSD $1,809
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $35,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,516
Amount paid for insurance broker fees1809
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number47-MSL-00039101
Policy instance 1
Insurance contract or identification number47-MSL-00039101
Number of Individuals Covered193
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $61,316
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $613,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,316
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0B769
Policy instance 3
Insurance contract or identification numberGLTD0B769
Number of Individuals Covered192
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $3,708
Total amount of fees paid to insurance companyUSD $1,725
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $52,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,708
Amount paid for insurance broker fees1725
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B769
Policy instance 2
Insurance contract or identification numberGUG0B769
Number of Individuals Covered192
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $2,461
Total amount of fees paid to insurance companyUSD $1,138
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $35,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,461
Amount paid for insurance broker fees1138
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407198
Policy instance 1
Insurance contract or identification number407198
Number of Individuals Covered210
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $52,805
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $528,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,805
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0B769
Policy instance 3
Insurance contract or identification numberGLTD0B769
Number of Individuals Covered172
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $3,277
Total amount of fees paid to insurance companyUSD $1,999
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $46,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,277
Amount paid for insurance broker fees1999
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number900284
Policy instance 1
Insurance contract or identification number900284
Number of Individuals Covered208
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $85,709
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $571,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,139
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B769
Policy instance 2
Insurance contract or identification numberGUG0B769
Number of Individuals Covered171
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $2,145
Total amount of fees paid to insurance companyUSD $1,294
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $30,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,145
Amount paid for insurance broker fees1294
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0B769
Policy instance 3
Insurance contract or identification numberGLTD0B769
Number of Individuals Covered160
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,856
Total amount of fees paid to insurance companyUSD $526
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $40,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,856
Amount paid for insurance broker fees526
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHIGGINBOTHAM INS AGENCY INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG0B769
Policy instance 2
Insurance contract or identification numberGUG0B769
Number of Individuals Covered160
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $1,885
Total amount of fees paid to insurance companyUSD $360
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $26,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,885
Amount paid for insurance broker fees360
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameHIG
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number900284
Policy instance 1
Insurance contract or identification number900284
Number of Individuals Covered192
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $57,990
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $386,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,660
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSTHEALTH BENEFIT SOLUTIONS LLC
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78C47ERC
Policy instance 1
Insurance contract or identification number78C47ERC
Number of Individuals Covered168
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $350,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78C47ERC
Policy instance 1
Insurance contract or identification number78C47ERC
Number of Individuals Covered170
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $460,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78C47ERC
Policy instance 1
Insurance contract or identification number78C47ERC
Number of Individuals Covered171
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $440,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number78C47ERC
Policy instance 1
Insurance contract or identification number78C47ERC
Number of Individuals Covered174
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $449,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number537688
Policy instance 1
Insurance contract or identification number537688
Number of Individuals Covered176
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $26,990
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,353,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number537688
Policy instance 1
Insurance contract or identification number537688
Number of Individuals Covered142
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $32,178
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $999,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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