Plan Ledger DOL Form 5500 · updated monthly

Plymouth Foam, LLCbenefits

Plymouth Foam, LLC Employee Health and Welfare Benefit Plan · PLYMOUTH, WI · plan year 2023

Broker compensation reported · 2023
$13,762

Plymouth Foam, LLC's benefits plan covered 0 active participants in 2023, providing health · life · dental · vision · short-term disability · long-term disability · death benefits · other. Insurance brokers and agents were paid $13,762 in commissions and fees, costs that ultimately come out of what the employer and employees pay for coverage.

Insurance contracts · 20234
EMPATHIA, INCpremiums n/a · 185 covered
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. · visionpremiums n/a · 187 covered
CONTINENTAL AMERICAN INSURANCE COMPANYpremiums n/a · 48 covered
UNITED OF OMAHA LIFE INSURANCE COMPANY · life std ltdpremiums n/a · 149 covered
Brokers & agents paid · 20234
JACK D. BREES AND VARIOUS AGENTS$259
4 individual agents · names withheld$903

Individual agents paid under $1,000 on this filing are shown as a total. The amounts are as filed; only the personal names are withheld.

Also brokered by Lockton5
Banner Health AZ$2,557,307

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Source: DOL Form 5500 Schedule A, plan year 2023, EIN 391631344 · Verify on EFAST2 · Amounts are as reported by the plan sponsor.