FORD RESTAURANT GROUP HEALTH AND WELFARE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FORD RESTAURANT GROUP WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: FORD RESTAURANT GROUP WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 317 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 363 |
| Total of all active and inactive participants | 2022-10-01 | 363 |
| 2021: FORD RESTAURANT GROUP WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 317 |
| Total of all active and inactive participants | 2021-10-01 | 317 |
| 2020: FORD RESTAURANT GROUP WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 277 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 363 |
| Total of all active and inactive participants | 2020-10-01 | 363 |
| 2019: FORD RESTAURANT GROUP WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 275 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 277 |
| Total of all active and inactive participants | 2019-10-01 | 277 |
| 2018: FORD RESTAURANT GROUP WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 275 |
| Total of all active and inactive participants | 2018-10-01 | 275 |
| 2017: FORD RESTAURANT GROUP WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 207 |
| Total of all active and inactive participants | 2017-10-01 | 207 |
| Total participants, beginning-of-year | 2017-01-01 | 239 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 150 |
| Total of all active and inactive participants | 2017-01-01 | 150 |
| 2016: FORD RESTAURANT GROUP WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 239 |
| Total of all active and inactive participants | 2016-01-01 | 239 |
| 2015: FORD RESTAURANT GROUP WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 229 |
| Total of all active and inactive participants | 2015-01-01 | 229 |
| 2014: FORD RESTAURANT GROUP WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 210 |
| Total of all active and inactive participants | 2014-01-01 | 210 |
| 2013: FORD RESTAURANT GROUP WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 168 |
| Total of all active and inactive participants | 2013-01-01 | 168 |
| 2012: FORD RESTAURANT GROUP WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 160 |
| Total of all active and inactive participants | 2012-01-01 | 160 |
| Total participants | 2012-01-01 | 160 |
| 2011: FORD RESTAURANT GROUP WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 145 |
| Total of all active and inactive participants | 2011-01-01 | 145 |
| Total participants | 2011-01-01 | 145 |
| 2022: FORD RESTAURANT GROUP WELFARE 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: FORD RESTAURANT GROUP WELFARE 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: FORD RESTAURANT GROUP WELFARE 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: FORD RESTAURANT GROUP WELFARE 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: FORD RESTAURANT GROUP WELFARE 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: FORD RESTAURANT GROUP WELFARE 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 |
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: FORD RESTAURANT GROUP WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: FORD RESTAURANT GROUP WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: FORD RESTAURANT GROUP WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: FORD RESTAURANT GROUP WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: FORD RESTAURANT GROUP WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: FORD RESTAURANT GROUP WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | First time form 5500 has been submitted | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 363 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $39,467 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VISION, AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,467 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $35,897 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VISION, AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,897 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 363 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $28,115 | | Total amount of fees paid to insurance company | USD $4,518 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VISION, AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,115 | | Amount paid for insurance broker fees | 4518 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $23,068 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VISION, AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,068 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 3 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $3,320 | | Total amount of fees paid to insurance company | USD $0 | | Vision 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 $3,320 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 2 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,928 | | 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 | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,928 |
|
| DEARBORN NATIONAL LIFE (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $17,637 | | Total amount of fees paid to insurance company | USD $5,752 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,637 | | Amount paid for insurance broker fees | 5752 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| DEARBORN NATIONAL LIFE (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F021692 |
| Policy instance | 1 |
| Insurance contract or identification number | F021692 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $18,771 | | Total amount of fees paid to insurance company | USD $9,647 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 699389 |
| Policy instance | 2 |
| Insurance contract or identification number | 699389 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-10-01 | | Total amount of commissions paid to insurance broker | USD $3,172 | | Total amount of fees paid to insurance company | USD $304 | | Other welfare benefits provided | LIFESTYLE LIFE AND LIFESTYLE ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,172 | | Amount paid for insurance broker fees | 304 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker name | MARSH & MCLENNAN INS AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-10-01 | | Total amount of commissions paid to insurance broker | USD $8,869 | | Total amount of fees paid to insurance company | USD $1,576 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY LIFE AND ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,869 | | Amount paid for insurance broker fees | 1576 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker name | MARSH & MCLENNAN INS AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 699389 |
| Policy instance | 2 |
| Insurance contract or identification number | 699389 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $1,129 | | Total amount of fees paid to insurance company | USD $221 | | Other welfare benefits provided | VOLUNTARY LIFE AND ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,129 | | Amount paid for insurance broker fees | 221 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker name | MARSH & MCLENNAN INS AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $8,992 | | Total amount of fees paid to insurance company | USD $1,803 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 $8,992 | | Amount paid for insurance broker fees | 1803 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE | | Insurance broker name | MARSH & MCLENNAN INS AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $9,461 | | Total amount of fees paid to insurance company | USD $1,727 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 $9,461 | | Amount paid for insurance broker fees | 1727 | | Insurance broker name | MC&H LIFE INS AGENCY INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $7,124 | | Total amount of fees paid to insurance company | USD $553 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 $4,636 | | Amount paid for insurance broker fees | 553 | | Insurance broker name | JOHN M. BLACK |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $7,372 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 $7,372 | | Insurance broker name | JOHN M. BLACK |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 539873 |
| Policy instance | 1 |
| Insurance contract or identification number | 539873 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $6,478 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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