| Insurance contract or identification number | AI110795 |
| Number of Individuals Covered | 259 |
| Insurance policy start date | 2023-08-01 |
| Insurance policy end date | 2023-12-31 |
| Total amount of commissions paid to insurance broker | USD $1,956 |
| Total amount of fees paid to insurance company | USD $0 |
| Health Insurance Welfare Benefit | No |
| Dental Insurance Welfare Benefit | No |
| Vision Insurance Welfare Benefit | No |
| Life Insurance Welfare Benefit | No |
| Temporary Disability Insurance Welfare Benefit | No |
| Long Term Disability Insurance Welfare Benefit | No |
| Unemployment Insurance Welfare Benefit | No |
| Other welfare benefits provided | ACCIDENT,CRITICAL ILLNESS,HOSPITAL |
| Welfare Benefit Premiums Paid to Carrier | USD $14,219 |
| Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |