RALLY CREDIT UNION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan RALLY CREDIT UNION HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: RALLY CREDIT UNION HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-11-01 | 602 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-11-01 | 642 |
| Number of retired or separated participants receiving benefits | 2022-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-11-01 | 0 |
| Total of all active and inactive participants | 2022-11-01 | 642 |
| Number of employers contributing to the scheme | 2022-11-01 | 0 |
| 2021: RALLY CREDIT UNION HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 580 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 602 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
| Total of all active and inactive participants | 2021-11-01 | 602 |
| Number of employers contributing to the scheme | 2021-11-01 | 0 |
| 2020: RALLY CREDIT UNION HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 556 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 580 |
| Number of retired or separated participants receiving benefits | 2020-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 0 |
| Total of all active and inactive participants | 2020-11-01 | 580 |
| Number of employers contributing to the scheme | 2020-11-01 | 0 |
| 2019: RALLY CREDIT UNION HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 525 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 556 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
| Total of all active and inactive participants | 2019-11-01 | 556 |
| Number of employers contributing to the scheme | 2019-11-01 | 0 |
| 2018: RALLY CREDIT UNION HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 491 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 527 |
| Number of retired or separated participants receiving benefits | 2018-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-11-01 | 0 |
| Total of all active and inactive participants | 2018-11-01 | 527 |
| Number of employers contributing to the scheme | 2018-11-01 | 0 |
| 2017: RALLY CREDIT UNION HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 491 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 619 |
| Number of retired or separated participants receiving benefits | 2017-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-11-01 | 0 |
| Total of all active and inactive participants | 2017-11-01 | 619 |
| Number of employers contributing to the scheme | 2017-11-01 | 0 |
| 2016: RALLY CREDIT UNION HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 393 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 403 |
| Number of retired or separated participants receiving benefits | 2016-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 0 |
| Total of all active and inactive participants | 2016-11-01 | 403 |
| 2015: RALLY CREDIT UNION HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 359 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 391 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 0 |
| Total of all active and inactive participants | 2015-11-01 | 391 |
| 2014: RALLY CREDIT UNION HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 304 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 359 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 0 |
| Total of all active and inactive participants | 2014-11-01 | 359 |
| 2013: RALLY CREDIT UNION HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 267 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 304 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 304 |
| 2012: RALLY CREDIT UNION HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 267 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 267 |
| 2011: RALLY CREDIT UNION HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 237 |
| Total of all active and inactive participants | 2011-11-01 | 237 |
| Total participants | 2011-11-01 | 237 |
| 2010: RALLY CREDIT UNION HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 204 |
| Total of all active and inactive participants | 2010-11-01 | 204 |
| Total participants | 2010-11-01 | 204 |
| 2009: RALLY CREDIT UNION HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 179 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 190 |
| Total of all active and inactive participants | 2009-11-01 | 190 |
| Total participants | 2009-11-01 | 190 |
| Measure | Date | Value |
|---|
| 2012 : RALLY CREDIT UNION HEALTH PLAN 2012 401k financial data |
|---|
| Total transfer of assets from this plan | 2012-10-31 | $943,179 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $45,423 |
| Total income from all sources (including contributions) | 2012-10-31 | $1,658,032 |
| Total of all expenses incurred | 2012-10-31 | $1,499,284 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-10-31 | $1,352,054 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-10-31 | $1,658,032 |
| Value of total assets at beginning of year | 2012-10-31 | $829,854 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-10-31 | $147,230 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-10-31 | No |
| Was this plan covered by a fidelity bond | 2012-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-10-31 | No |
| Contributions received from participants | 2012-10-31 | $180,325 |
| Participant contributions at beginning of year | 2012-10-31 | $14,873 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-10-31 | $45,423 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-10-31 | $3,190 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-10-31 | $45,423 |
| Administrative expenses (other) incurred | 2012-10-31 | $147,230 |
| Total non interest bearing cash at beginning of year | 2012-10-31 | $698,500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Value of net income/loss | 2012-10-31 | $158,748 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-10-31 | $784,431 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-10-31 | $309,919 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-10-31 | No |
| Contributions received in cash from employer | 2012-10-31 | $1,432,284 |
| Employer contributions (assets) at beginning of year | 2012-10-31 | $113,291 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-10-31 | $1,042,135 |
| Did the plan have assets held for investment | 2012-10-31 | 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 | 2012-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-10-31 | Unqualified |
| Accountancy firm name | 2012-10-31 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2012-10-31 | 410746749 |
| 2011 : RALLY CREDIT UNION HEALTH PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $45,423 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $230,036 |
| Total income from all sources (including contributions) | 2011-10-31 | $1,642,489 |
| Total of all expenses incurred | 2011-10-31 | $1,075,958 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-10-31 | $944,061 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-10-31 | $1,642,489 |
| Value of total assets at end of year | 2011-10-31 | $829,854 |
| Value of total assets at beginning of year | 2011-10-31 | $447,936 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-10-31 | $131,897 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-10-31 | No |
| Was this plan covered by a fidelity bond | 2011-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-10-31 | No |
| Contributions received from participants | 2011-10-31 | $176,815 |
| Participant contributions at end of year | 2011-10-31 | $14,873 |
| Participant contributions at beginning of year | 2011-10-31 | $12,541 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-10-31 | $157,080 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-10-31 | $3,190 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-10-31 | $2,292 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-10-31 | $45,423 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-10-31 | $202,503 |
| Administrative expenses (other) incurred | 2011-10-31 | $131,897 |
| Liabilities. Value of operating payables at beginning of year | 2011-10-31 | $27,533 |
| Total non interest bearing cash at end of year | 2011-10-31 | $698,500 |
| Total non interest bearing cash at beginning of year | 2011-10-31 | $339,052 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Value of net income/loss | 2011-10-31 | $566,531 |
| Value of net assets at end of year (total assets less liabilities) | 2011-10-31 | $784,431 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-10-31 | $217,900 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-10-31 | $292,871 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-10-31 | No |
| Contributions received in cash from employer | 2011-10-31 | $1,308,594 |
| Employer contributions (assets) at end of year | 2011-10-31 | $113,291 |
| Employer contributions (assets) at beginning of year | 2011-10-31 | $94,051 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-10-31 | $651,190 |
| Did the plan have assets held for investment | 2011-10-31 | 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 | 2011-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-10-31 | Unqualified |
| Accountancy firm name | 2011-10-31 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2011-10-31 | 410746749 |
| 2022: RALLY CREDIT UNION HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: RALLY CREDIT UNION HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: RALLY CREDIT UNION HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: RALLY CREDIT UNION HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: RALLY CREDIT UNION HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: RALLY CREDIT UNION HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: RALLY CREDIT UNION HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: RALLY CREDIT UNION HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: RALLY CREDIT UNION HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: RALLY CREDIT UNION HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: RALLY CREDIT UNION HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: RALLY CREDIT UNION HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – Trust | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement - Trust | Yes |
| 2010: RALLY CREDIT UNION HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan funding arrangement – Trust | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement - Trust | Yes |
| 2009: RALLY CREDIT UNION HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – Trust | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement - Trust | Yes |
| 2008: RALLY CREDIT UNION HEALTH PLAN 2008 form 5500 responses |
|---|
| 2008-11-01 | Type of plan entity | Single employer plan |
| 2008-11-01 | Submission has been amended | No |
| 2008-11-01 | This submission is the final filing | No |
| 2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-11-01 | Plan is a collectively bargained plan | No |
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 8801638 |
| Policy instance | 6 |
| Insurance contract or identification number | 8801638 | | Number of Individuals Covered | 711 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | TELEHEALTH | | Welfare Benefit Premiums Paid to Carrier | USD $25,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40320 |
| Policy instance | 5 |
| Insurance contract or identification number | HCCLOT40320 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $8,096 | | Total amount of fees paid to insurance company | USD $2,675 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $80,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,096 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 4 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $26,443 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $149,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,229 | | 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 | 948178 |
| Policy instance | 3 |
| Insurance contract or identification number | 948178 | | Number of Individuals Covered | 654 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $69,144 | | 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 $462,178 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,144 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 1073 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $6,141 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,141 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 1002 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $31,798 | | Total amount of fees paid to insurance company | USD $4,144 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $362,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,798 | | Amount paid for insurance broker fees | 63 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 995 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $31,041 | | Total amount of fees paid to insurance company | USD $5,536 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $322,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,041 | | Amount paid for insurance broker fees | 54 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $6,085 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,848 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,085 | | 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 | 948178 |
| Policy instance | 3 |
| Insurance contract or identification number | 948178 | | Number of Individuals Covered | 602 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $57,184 | | Total amount of fees paid to insurance company | USD $20,608 | | 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 $415,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,184 | | Amount paid for insurance broker fees | 20608 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 4 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $25,846 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $151,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,608 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40320 |
| Policy instance | 5 |
| Insurance contract or identification number | HCCLOT40320 | | Number of Individuals Covered | 622 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $10,277 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $75,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 7557 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 8801638 |
| Policy instance | 6 |
| Insurance contract or identification number | 8801638 | | Number of Individuals Covered | 602 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | 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 $5,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BFKN |
| Policy instance | 6 |
| Insurance contract or identification number | GLUG0BFKN | | Number of Individuals Covered | 580 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $46,928 | | Total amount of fees paid to insurance company | USD $16,615 | | 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 $296,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,928 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 580 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40320 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40320 | | Number of Individuals Covered | 566 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $6,634 | | Total amount of fees paid to insurance company | USD $2,388 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $6,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,317 | | Amount paid for insurance broker fees | 1194 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 3 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $14,997 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $130,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,070 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 573 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $5,161 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,161 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 919 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $37,689 | | Total amount of fees paid to insurance company | USD $5,655 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $315,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,689 | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BFKN |
| Policy instance | 6 |
| Insurance contract or identification number | GLUG0BFKN | | Number of Individuals Covered | 560 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $43,185 | | Total amount of fees paid to insurance company | USD $15,565 | | 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 $272,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,185 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 542 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $7,138 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,512 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,138 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40320 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40320 | | Number of Individuals Covered | 548 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $6,175 | | Total amount of fees paid to insurance company | USD $2,223 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $61,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,175 | | Amount paid for insurance broker fees | 2223 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 3 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $27,427 | | Total amount of fees paid to insurance company | USD $98 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $150,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,602 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 564 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $5,115 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $5,115 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 898 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $22,978 | | Total amount of fees paid to insurance company | USD $3,638 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $283,221 | | 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 | 3543 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 805 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $25,660 | | Total amount of fees paid to insurance company | USD $3,317 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $279,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,660 | | Amount paid for insurance broker fees | 75 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $4,838 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $4,838 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 3 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $25,385 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $154,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,161 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40285 |
| Policy instance | 4 |
| Insurance contract or identification number | HCCLOT40285 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $5,923 | | Total amount of fees paid to insurance company | USD $2,132 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $59,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $5,923 | | Amount paid for insurance broker fees | 2132 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 625 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | 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 $22,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BFKN |
| Policy instance | 6 |
| Insurance contract or identification number | GLUG0BFKN | | Number of Individuals Covered | 513 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $36,938 | | Total amount of fees paid to insurance company | USD $10,381 | | 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 $237,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,938 | | Amount paid for insurance broker fees | 9229 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 619 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 53891 |
| Policy instance | 4 |
| Insurance contract or identification number | 53891 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $19,584 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER, HEART/STROKE | | Welfare Benefit Premiums Paid to Carrier | USD $142,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 1393 |
| Policy instance | 3 |
| Insurance contract or identification number | 1393 | | Number of Individuals Covered | 462 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $33,159 | | 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 $216,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5912341 |
| Policy instance | 1 |
| Insurance contract or identification number | 5912341 | | Number of Individuals Covered | 803 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $25,644 | | Total amount of fees paid to insurance company | USD $3,439 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $258,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
| Policy contract number | 325970 |
| Policy instance | 2 |
| Insurance contract or identification number | 325970 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $4,831 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
