401k Plan data: RAE CORPORATION plan

RAE CORPORATION 401k Plan overview

Plan Name	RAE CORPORATION
Plan identification number	501

RAE CORPORATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

RAE CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: RAE CORPORATION

Employer identification number (EIN): 730798677

NAIC Classification: 333410

Additional information about RAE CORPORATION

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 0567803

More information about RAE CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RAE CORPORATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 DAN CROFFORD 2023-05-22
501 2021-01-01 DAN CROFFORD 2022-06-10
501 2020-01-01 DAN CROFFORD 2021-06-24
501 2019-01-01 DAN CROFFORD 2020-07-07
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 VICKIE STEPHENS
501 2011-01-01 VICKIE STEPHENS
501 2010-01-01 VICKIE STEPHENS
501 2009-01-01 VICKIE STEPHENS

Plan Statistics for RAE CORPORATION

401k plan membership statisitcs for RAE CORPORATION

Measure Date Value
2022: RAE CORPORATION 2022 401k membership
Total participants, beginning-of-year 2022-01-01 323
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 508
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 508
Number of employers contributing to the scheme 2022-01-01 0
2021: RAE CORPORATION 2021 401k membership
Total participants, beginning-of-year 2021-01-01 387
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 323
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 323
Number of employers contributing to the scheme 2021-01-01 0
2020: RAE CORPORATION 2020 401k membership
Total participants, beginning-of-year 2020-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 387
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 387
Number of employers contributing to the scheme 2020-01-01 0
2019: RAE CORPORATION 2019 401k membership
Total participants, beginning-of-year 2019-01-01 323
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 323
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 323
Number of employers contributing to the scheme 2019-01-01 0
2018: RAE CORPORATION 2018 401k membership
Total participants, beginning-of-year 2018-01-01 443
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 323
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 323
Number of employers contributing to the scheme 2018-01-01 0
2017: RAE CORPORATION 2017 401k membership
Total participants, beginning-of-year 2017-01-01 379
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 443
Total of all active and inactive participants 2017-01-01 443
2016: RAE CORPORATION 2016 401k membership
Total participants, beginning-of-year 2016-01-01 352
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 379
Total of all active and inactive participants 2016-01-01 379
2015: RAE CORPORATION 2015 401k membership
Total participants, beginning-of-year 2015-01-01 293
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 352
Total of all active and inactive participants 2015-01-01 352
2014: RAE CORPORATION 2014 401k membership
Total participants, beginning-of-year 2014-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 293
Total of all active and inactive participants 2014-01-01 293
2013: RAE CORPORATION 2013 401k membership
Total participants, beginning-of-year 2013-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 279
Total of all active and inactive participants 2013-01-01 279
2012: RAE CORPORATION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 264
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 281
Total of all active and inactive participants 2012-01-01 281
2011: RAE CORPORATION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 188
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 264
Total of all active and inactive participants 2011-01-01 264
2010: RAE CORPORATION 2010 401k membership
Total participants, beginning-of-year 2010-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 188
Total of all active and inactive participants 2010-01-01 188
2009: RAE CORPORATION 2009 401k membership
Total participants, beginning-of-year 2009-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 191
Total of all active and inactive participants 2009-01-01 191

Measure	Date	Value
2022: RAE CORPORATION 2022 401k membership
Total participants, beginning-of-year	2022-01-01	323
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	508
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	508
Number of employers contributing to the scheme	2022-01-01	0
2021: RAE CORPORATION 2021 401k membership
Total participants, beginning-of-year	2021-01-01	387
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	323
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	323
Number of employers contributing to the scheme	2021-01-01	0
2020: RAE CORPORATION 2020 401k membership
Total participants, beginning-of-year	2020-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	387
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	387
Number of employers contributing to the scheme	2020-01-01	0
2019: RAE CORPORATION 2019 401k membership
Total participants, beginning-of-year	2019-01-01	323
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	323
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	323
Number of employers contributing to the scheme	2019-01-01	0
2018: RAE CORPORATION 2018 401k membership
Total participants, beginning-of-year	2018-01-01	443
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	323
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	323
Number of employers contributing to the scheme	2018-01-01	0
2017: RAE CORPORATION 2017 401k membership
Total participants, beginning-of-year	2017-01-01	379
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	443
Total of all active and inactive participants	2017-01-01	443
2016: RAE CORPORATION 2016 401k membership
Total participants, beginning-of-year	2016-01-01	352
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	379
Total of all active and inactive participants	2016-01-01	379
2015: RAE CORPORATION 2015 401k membership
Total participants, beginning-of-year	2015-01-01	293
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	352
Total of all active and inactive participants	2015-01-01	352
2014: RAE CORPORATION 2014 401k membership
Total participants, beginning-of-year	2014-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	293
Total of all active and inactive participants	2014-01-01	293
2013: RAE CORPORATION 2013 401k membership
Total participants, beginning-of-year	2013-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	279
Total of all active and inactive participants	2013-01-01	279
2012: RAE CORPORATION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	264
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	281
Total of all active and inactive participants	2012-01-01	281
2011: RAE CORPORATION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	188
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	264
Total of all active and inactive participants	2011-01-01	264
2010: RAE CORPORATION 2010 401k membership
Total participants, beginning-of-year	2010-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	188
Total of all active and inactive participants	2010-01-01	188
2009: RAE CORPORATION 2009 401k membership
Total participants, beginning-of-year	2009-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	191
Total of all active and inactive participants	2009-01-01	191

Financial Data on RAE CORPORATION

Measure	Date	Value
2010 : RAE CORPORATION 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
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	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No

Form 5500 Responses for RAE CORPORATION

2022: RAE CORPORATION 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: RAE CORPORATION 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: RAE CORPORATION 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: RAE CORPORATION 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: RAE CORPORATION 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: RAE CORPORATION 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: RAE CORPORATION 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: RAE CORPORATION 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: RAE CORPORATION 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: RAE CORPORATION 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: RAE CORPORATION 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: RAE CORPORATION 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: RAE CORPORATION 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: RAE CORPORATION 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

RAE CORP

Policy instance

Insurance contract or identification number	RAE CORP
Number of Individuals Covered	508
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $6,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

922340

Policy instance

Insurance contract or identification number	922340
Number of Individuals Covered	99
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,437
Total amount of fees paid to insurance company	USD $664
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,437
Amount paid for insurance broker fees	664
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

1429

Policy instance

Insurance contract or identification number	1429
Number of Individuals Covered	468
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,845
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $114,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $15,845
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	256
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,558
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,558
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	231
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,148
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,148
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	256
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,686
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,686
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	223
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,461
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,461
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

1429

Policy instance

Insurance contract or identification number	1429
Number of Individuals Covered	323
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,458
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $93,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,458
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

922340

Policy instance

Insurance contract or identification number	922340
Number of Individuals Covered	104
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,459
Total amount of fees paid to insurance company	USD $675
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $34,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,459
Amount paid for insurance broker fees	675
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

RAE CORP

Policy instance

Insurance contract or identification number	RAE CORP
Number of Individuals Covered	508
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	222
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,453
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,453
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	207
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,460
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,460
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

1429

Policy instance

Insurance contract or identification number	1429
Number of Individuals Covered	323
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $14,885
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $85,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $14,885
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

922340

Policy instance

Insurance contract or identification number	922340
Number of Individuals Covered	86
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,649
Total amount of fees paid to insurance company	USD $708
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $38,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,649
Amount paid for insurance broker fees	708
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

RAE CORP

Policy instance

Insurance contract or identification number	RAE CORP
Number of Individuals Covered	319
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	218
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,212
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,212
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	206
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,217
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,217
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

1429

Policy instance

Insurance contract or identification number	1429
Number of Individuals Covered	323
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,565
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $85,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,565
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

78481

Policy instance

Insurance contract or identification number	78481
Number of Individuals Covered	47
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,694
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $30,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,327
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

922340

Policy instance

Insurance contract or identification number	922340
Number of Individuals Covered	95
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,818
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $37,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,818
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

RAE CORP

Policy instance

Insurance contract or identification number	RAE CORP
Number of Individuals Covered	319
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	230
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,603
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,603
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	200
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,347
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,347
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

001429

Policy instance

Insurance contract or identification number	001429
Number of Individuals Covered	323
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,436
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $83,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $13,436
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

78481

Policy instance

Insurance contract or identification number	78481
Number of Individuals Covered	323
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,425
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $27,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,453
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5482335

Policy instance

Insurance contract or identification number	5482335
Number of Individuals Covered	55
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,210
Total amount of fees paid to insurance company	USD $738
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $26,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,210
Amount paid for insurance broker fees	738
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	175
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,298
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1298
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	209
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	HUB INTERNATIONAL CFR

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0869636-0869636

Policy instance

Insurance contract or identification number	0869636-0869636
Number of Individuals Covered	443
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,014,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0869636-0284628

Policy instance

Insurance contract or identification number	0869636-0284628
Number of Individuals Covered	403
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $8,482
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFE & AD&D- VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $62,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	8482
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL CFR

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,730
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC & DEP LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,730
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

123715

Policy instance

Insurance contract or identification number	123715
Number of Individuals Covered	352
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,345,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,397
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,397
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	144
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	HUB INTERNATIONAL CFR

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	122
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $938
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $938
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	280
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $3,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL CFR

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

580663085

Policy instance

Insurance contract or identification number	580663085
Number of Individuals Covered	83
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,116
Total amount of fees paid to insurance company	USD $850
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,974
Amount paid for insurance broker fees	532
Insurance broker organization code?	3
Insurance broker name	TRAVIS HURT

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AKPE

Policy instance

Insurance contract or identification number	G000AKPE
Number of Individuals Covered	116
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,004
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFE & AD&D- VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $36,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,004
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $845
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $845
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

123715

Policy instance

Insurance contract or identification number	123715
Number of Individuals Covered	293
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,819
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,036,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,819
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	238
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,421
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC & DEP LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $9,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,421
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	214
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,879
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $3,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3879
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL CFR

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AKPE

Policy instance

Insurance contract or identification number	G000AKPE
Number of Individuals Covered	100
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,831
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFE & AD&D- VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $35,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,831
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

580663085

Policy instance

Insurance contract or identification number	580663085
Number of Individuals Covered	57
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,741
Total amount of fees paid to insurance company	USD $194
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,720
Amount paid for insurance broker fees	121
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	2.68
Insurance broker name	CURTIS W OGLESBY

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	81
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,374
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,374
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

580663085

Policy instance

Insurance contract or identification number	580663085
Number of Individuals Covered	54
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,890
Total amount of fees paid to insurance company	USD $32
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,411
Amount paid for insurance broker fees	20
Insurance broker organization code?	3
Insurance broker name	CURTIS W OGLESBY

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	279
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $45,541
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $907,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	22992
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL CFR

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	107
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	209
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,500
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC & DEP LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $9,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $966
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL CFR

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	79
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,433
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,554
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $854
Insurance broker organization code?	3
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AKPE

Policy instance

Insurance contract or identification number	G000AKPE
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,158
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $34,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,095
Insurance broker organization code?	3
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	84
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $820
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $547
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL MIDWEST LIMITED

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

580663085

Policy instance

Insurance contract or identification number	580663085
Number of Individuals Covered	35
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,835
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,964
Insurance broker organization code?	3
Insurance broker name	CURTIS W OGLESBY

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	281
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $45,930
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $884,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	45930
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	79
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	103
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	83
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,312
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,312
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G0000AKPE

Policy instance

Insurance contract or identification number	G0000AKPE
Number of Individuals Covered	202
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,214
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC & DEP LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $8,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,214
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000AKPE

Policy instance

Insurance contract or identification number	G000AKPE
Number of Individuals Covered	101
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,557
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $30,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,557
Insurance broker organization code?	3
Insurance broker name	INTEGRATED INSURANCE SVRS AGCY LLC

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	264
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $43,098
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $826,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

78481

Policy instance

Insurance contract or identification number	78481
Number of Individuals Covered	33
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,447
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $15,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM601791

Policy instance

Insurance contract or identification number	SGM601791
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,295
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC & DEP LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	98
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD601705

Policy instance

Insurance contract or identification number	SGD601705
Number of Individuals Covered	78
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,481
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	72
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM601792

Policy instance

Insurance contract or identification number	SGM601792
Number of Individuals Covered	152
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,534
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $36,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )

Policy contract number

C01182

Policy instance

Insurance contract or identification number	C01182
Number of Individuals Covered	187
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $34,480
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $689,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM601791

Policy instance

Insurance contract or identification number	SGM601791
Number of Individuals Covered	188
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

78481

Policy instance

Insurance contract or identification number	78481
Number of Individuals Covered	31
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,014
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

9585

Policy instance

Insurance contract or identification number	9585
Number of Individuals Covered	94
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,936
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

30018177

Policy instance

Insurance contract or identification number	30018177
Number of Individuals Covered	64
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $691
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	RAE CORPORATION
Employer identification number (EIN):	730798677
NAIC Classification:	333410

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	0567803

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	DAN CROFFORD	2023-05-22
501	2021-01-01	DAN CROFFORD	2022-06-10
501	2020-01-01	DAN CROFFORD	2021-06-24
501	2019-01-01	DAN CROFFORD	2020-07-07
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	VICKIE STEPHENS
501	2011-01-01	VICKIE STEPHENS
501	2010-01-01	VICKIE STEPHENS
501	2009-01-01	VICKIE STEPHENS