ADDVANTAGE TECHNOLOGIES GROUP, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 119 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 18 |
| Total of all active and inactive participants | 2022-10-01 | 141 |
| Number of employers contributing to the scheme | 2022-10-01 | 0 |
| 2021: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 110 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 9 |
| Total of all active and inactive participants | 2021-10-01 | 121 |
| Number of employers contributing to the scheme | 2021-10-01 | 0 |
| 2020: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 133 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 1 |
| Total of all active and inactive participants | 2020-10-01 | 141 |
| Number of employers contributing to the scheme | 2020-10-01 | 0 |
| 2019: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 224 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 112 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 5 |
| Total of all active and inactive participants | 2019-10-01 | 121 |
| Number of employers contributing to the scheme | 2019-10-01 | 0 |
| 2018: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 212 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 11 |
| Total of all active and inactive participants | 2018-10-01 | 224 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| 2017: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 148 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 3 |
| Total of all active and inactive participants | 2017-10-01 | 155 |
| Number of employers contributing to the scheme | 2017-10-01 | 0 |
| 2016: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 166 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 11 |
| Total of all active and inactive participants | 2016-10-01 | 178 |
| 2015: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 144 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 144 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 144 |
| 2014: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 144 |
| Total of all active and inactive participants | 2014-10-01 | 144 |
| Total participants | 2014-10-01 | 144 |
| 2013: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 127 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
| Total of all active and inactive participants | 2013-10-01 | 127 |
| Total participants | 2013-10-01 | 127 |
| 2012: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 130 |
| Total of all active and inactive participants | 2012-10-01 | 130 |
| 2011: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 136 |
| Total of all active and inactive participants | 2011-10-01 | 136 |
| Total participants | 2011-10-01 | 136 |
| 2009: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 141 |
| Total of all active and inactive participants | 2009-10-01 | 141 |
| Total participants | 2009-10-01 | 141 |
| 2008: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-10-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 126 |
| Total of all active and inactive participants | 2008-10-01 | 126 |
| Total participants | 2008-10-01 | 126 |
| 2007: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-10-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-10-01 | 154 |
| Total of all active and inactive participants | 2007-10-01 | 154 |
| Total participants | 2007-10-01 | 154 |
| 2006: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-10-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-10-01 | 172 |
| Total of all active and inactive participants | 2006-10-01 | 172 |
| Total participants | 2006-10-01 | 172 |
| 2005: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-10-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-10-01 | 122 |
| Total of all active and inactive participants | 2005-10-01 | 122 |
| Total participants | 2005-10-01 | 122 |
| 2004: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-10-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-10-01 | 142 |
| Total of all active and inactive participants | 2004-10-01 | 142 |
| Total participants | 2004-10-01 | 142 |
| 2003: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-10-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-10-01 | 160 |
| Total of all active and inactive participants | 2003-10-01 | 160 |
| Total participants | 2003-10-01 | 160 |
| 2022: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | First time form 5500 has been submitted | Yes |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | First time form 5500 has been submitted | Yes |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | First time form 5500 has been submitted | Yes |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | First time form 5500 has been submitted | Yes |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | First time form 5500 has been submitted | Yes |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | First time form 5500 has been submitted | Yes |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| 2008-10-01 | Plan funding arrangement – Insurance | Yes |
| 2008-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2007 form 5500 responses |
|---|
| 2007-10-01 | Type of plan entity | Single employer plan |
| 2007-10-01 | First time form 5500 has been submitted | Yes |
| 2007-10-01 | Submission has been amended | No |
| 2007-10-01 | This submission is the final filing | No |
| 2007-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-10-01 | Plan is a collectively bargained plan | No |
| 2007-10-01 | Plan funding arrangement – Insurance | Yes |
| 2007-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2006 form 5500 responses |
|---|
| 2006-10-01 | Type of plan entity | Single employer plan |
| 2006-10-01 | First time form 5500 has been submitted | Yes |
| 2006-10-01 | Submission has been amended | No |
| 2006-10-01 | This submission is the final filing | No |
| 2006-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-10-01 | Plan is a collectively bargained plan | No |
| 2006-10-01 | Plan funding arrangement – Insurance | Yes |
| 2006-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2005 form 5500 responses |
|---|
| 2005-10-01 | Type of plan entity | Single employer plan |
| 2005-10-01 | First time form 5500 has been submitted | Yes |
| 2005-10-01 | Submission has been amended | No |
| 2005-10-01 | This submission is the final filing | No |
| 2005-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-10-01 | Plan is a collectively bargained plan | No |
| 2005-10-01 | Plan funding arrangement – Insurance | Yes |
| 2005-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2004 form 5500 responses |
|---|
| 2004-10-01 | Type of plan entity | Single employer plan |
| 2004-10-01 | First time form 5500 has been submitted | Yes |
| 2004-10-01 | Submission has been amended | No |
| 2004-10-01 | This submission is the final filing | No |
| 2004-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-10-01 | Plan is a collectively bargained plan | No |
| 2004-10-01 | Plan funding arrangement – Insurance | Yes |
| 2004-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: ADDVANTAGE TECHNOLOGIES GROUP HEALTH PLAN 2003 form 5500 responses |
|---|
| 2003-10-01 | Type of plan entity | Single employer plan |
| 2003-10-01 | First time form 5500 has been submitted | Yes |
| 2003-10-01 | Submission has been amended | No |
| 2003-10-01 | This submission is the final filing | No |
| 2003-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-10-01 | Plan is a collectively bargained plan | No |
| 2003-10-01 | Plan funding arrangement – Insurance | Yes |
| 2003-10-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 922096 |
| Policy instance | 2 |
| Insurance contract or identification number | 922096 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $21,633 | | Total amount of fees paid to insurance company | USD $82,346 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,811,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,905 | | Amount paid for insurance broker fees | 82346 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 21443 |
| Policy instance | 1 |
| Insurance contract or identification number | 21443 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $8,545 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $8,545 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 922096 |
| Policy instance | 2 |
| Insurance contract or identification number | 922096 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $19,963 | | Total amount of fees paid to insurance company | USD $81,963 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,647,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,282 | | Amount paid for insurance broker fees | 81963 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 21443 |
| Policy instance | 1 |
| Insurance contract or identification number | 21443 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $7,001 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $7,001 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 922096 |
| Policy instance | 3 |
| Insurance contract or identification number | 922096 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $843 | | Total amount of fees paid to insurance company | USD $64,812 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,235,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $843 | | Amount paid for insurance broker fees | 64812 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 305757 |
| Policy instance | 2 |
| Insurance contract or identification number | 305757 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $2,456 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $101,447 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,456 | | 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 | 9840 |
| Policy instance | 1 |
| Insurance contract or identification number | 9840 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $6,364 | | 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 $6,364 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 305757 |
| Policy instance | 3 |
| Insurance contract or identification number | 305757 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $14,519 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $105,318 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,519 | | 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 | 9840 |
| Policy instance | 2 |
| Insurance contract or identification number | 9840 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $6,867 | | 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 $6,867 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 120678 |
| Policy instance | 1 |
| Insurance contract or identification number | 120678 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $68,905 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,363,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 68905 | | Additional information about fees paid to insurance broker | 2019 PPP - MEDICAL NEW BUSINESS RISK 2019 PPP SPECIALITY NEW BUSINESS RISK DIRECT COMP. INDIRECT COMP. | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 909157 |
| Policy instance | 2 |
| Insurance contract or identification number | 909157 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $14,287 | | Total amount of fees paid to insurance company | USD $67,302 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,478,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,287 | | Amount paid for insurance broker fees | 67302 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT BONUS | | Insurance broker organization code? | 3 |
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| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 9840 |
| Policy instance | 1 |
| Insurance contract or identification number | 9840 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $6,207 | | 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 $6,207 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM605554 |
| Policy instance | 5 |
| Insurance contract or identification number | SGM605554 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $8,668 | | Total amount of fees paid to insurance company | USD $733 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $55,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 9840 |
| Policy instance | 4 |
| Insurance contract or identification number | 9840 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $4,191 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 909157 |
| Policy instance | 3 |
| Insurance contract or identification number | 909157 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $48,485 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $921,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99204971001 |
| Policy instance | 2 |
| Insurance contract or identification number | 99204971001 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $849 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 0101533300 |
| Policy instance | 1 |
| Insurance contract or identification number | 0101533300 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $2,033 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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