MID SOUTH EXTRUSION, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST
401k plan membership statisitcs for MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST
| Measure | Date | Value |
|---|
| 2023 : MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST 2023 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $19,227 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $21,019 |
| Total income from all sources (including contributions) | 2023-12-31 | $1,306,480 |
| Total of all expenses incurred | 2023-12-31 | $1,100,884 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $991,477 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $1,242,368 |
| Value of total assets at end of year | 2023-12-31 | $593,100 |
| Value of total assets at beginning of year | 2023-12-31 | $389,296 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $109,407 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Was this plan covered by a fidelity bond | 2023-12-31 | Yes |
| Value of fidelity bond cover | 2023-12-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2023-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $88,754 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $28,531 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $48,175 |
| Other income not declared elsewhere | 2023-12-31 | $64,112 |
| Administrative expenses (other) incurred | 2023-12-31 | $109,407 |
| Total non interest bearing cash at end of year | 2023-12-31 | $564,569 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $341,121 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $205,596 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $573,873 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $368,277 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $381,708 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $1,153,614 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $609,769 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $19,227 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $21,019 |
| Did the plan have assets held for investment | 2023-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2023-12-31 | 721447940 |
| 2022 : MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $21,019 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $38,171 |
| Total income from all sources (including contributions) | 2022-12-31 | $1,328,371 |
| Total of all expenses incurred | 2022-12-31 | $1,117,768 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $1,005,433 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $1,234,286 |
| Value of total assets at end of year | 2022-12-31 | $389,296 |
| Value of total assets at beginning of year | 2022-12-31 | $195,845 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $112,335 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $101,220 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $48,175 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $1,271 |
| Other income not declared elsewhere | 2022-12-31 | $94,085 |
| Administrative expenses (other) incurred | 2022-12-31 | $112,335 |
| Total non interest bearing cash at end of year | 2022-12-31 | $341,121 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $194,574 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $210,603 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $368,277 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $157,674 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $377,947 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $1,133,066 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $627,486 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $21,019 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $38,171 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2022-12-31 | 721447940 |
| 2021 : MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $38,171 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $66,804 |
| Total income from all sources (including contributions) | 2021-12-31 | $1,280,370 |
| Total of all expenses incurred | 2021-12-31 | $1,159,327 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $1,057,762 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $1,237,725 |
| Value of total assets at end of year | 2021-12-31 | $195,845 |
| Value of total assets at beginning of year | 2021-12-31 | $103,435 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $101,565 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $109,678 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $1,271 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $57,924 |
| Other income not declared elsewhere | 2021-12-31 | $42,645 |
| Administrative expenses (other) incurred | 2021-12-31 | $101,565 |
| Total non interest bearing cash at end of year | 2021-12-31 | $194,574 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $45,511 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $121,043 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $157,674 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $36,631 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $360,049 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $1,128,047 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $697,713 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $38,171 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $66,804 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2021-12-31 | 721447940 |
| 2020 : MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $66,804 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $30,346 |
| Total income from all sources (including contributions) | 2020-12-31 | $1,304,860 |
| Total of all expenses incurred | 2020-12-31 | $1,300,298 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $1,205,916 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $1,131,553 |
| Value of total assets at end of year | 2020-12-31 | $103,435 |
| Value of total assets at beginning of year | 2020-12-31 | $62,415 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $94,382 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $124,575 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $57,924 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $22,265 |
| Other income not declared elsewhere | 2020-12-31 | $173,307 |
| Administrative expenses (other) incurred | 2020-12-31 | $94,382 |
| Total non interest bearing cash at end of year | 2020-12-31 | $45,511 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $40,150 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $4,562 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $36,631 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $32,069 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $371,548 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $1,006,978 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $834,368 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $66,804 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $30,346 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2020-12-31 | 721447940 |
| 2019 : MID SOUTH EXTRUSION, INC. EMPLOYEE BENEFIT PLAN & TRUST 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $30,346 |
| Total income from all sources (including contributions) | 2019-12-31 | $1,068,707 |
| Total of all expenses incurred | 2019-12-31 | $1,036,638 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $965,956 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $949,671 |
| Value of total assets at end of year | 2019-12-31 | $62,415 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $70,682 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $122,129 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $22,265 |
| Other income not declared elsewhere | 2019-12-31 | $119,036 |
| Administrative expenses (other) incurred | 2019-12-31 | $70,682 |
| Total non interest bearing cash at end of year | 2019-12-31 | $40,150 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $32,069 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $32,069 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $307,772 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $827,542 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $658,184 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $30,346 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | BROUSSARD & COMPANY CPA'S, LLC |
| Accountancy firm EIN | 2019-12-31 | 721447940 |
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 141 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $3,465 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $10,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 141 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $825 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $10,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 141 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $1,650 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $14,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 141 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $40,009 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $259,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $39,013 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $252,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,013 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,704 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $15,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,704 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $852 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $11,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $852 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,556 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $11,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,556 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 144 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,358 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $10,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,358 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 144 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $786 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,646 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $786 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 144 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,572 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $14,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,572 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 144 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $39,065 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $253,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,065 | | Insurance broker organization code? | 5 |
|
| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $41,525 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $270,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,525 | | Insurance broker organization code? | 5 |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,401 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $12,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,401 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $701 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $701 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,102 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,102 | | Insurance broker organization code? | 5 |
|
| MULTIPLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 5 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,907 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,907 | | Insurance broker organization code? | 5 |
|
| VERITY HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PPO PLUS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,271 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,271 | | Insurance broker organization code? | 5 |
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| PHOENIX EXCESS RISK (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $33,747 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $219,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,747 | | Insurance broker organization code? | 5 |
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