BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI, A MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS
401k plan membership statisitcs for BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS
| Measure | Date | Value |
|---|
| 2022: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 367 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 344 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 344 |
| 2021: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 392 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 367 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
| Total of all active and inactive participants | 2021-04-01 | 367 |
| 2020: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 406 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 396 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
| Total of all active and inactive participants | 2020-04-01 | 396 |
| 2019: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 429 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 406 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 406 |
| 2018: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 413 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 429 |
| Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
| Total of all active and inactive participants | 2018-04-01 | 429 |
| 2017: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 394 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 413 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
| Total of all active and inactive participants | 2017-04-01 | 413 |
| 2016: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 424 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 394 |
| Total of all active and inactive participants | 2016-04-01 | 394 |
| 2015: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 412 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 424 |
| Total of all active and inactive participants | 2015-04-01 | 424 |
| 2014: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 431 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 417 |
| Total of all active and inactive participants | 2014-04-01 | 417 |
| 2013: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 444 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 435 |
| Total of all active and inactive participants | 2013-04-01 | 435 |
| 2012: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 456 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 444 |
| Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
| Total of all active and inactive participants | 2012-04-01 | 444 |
| 2011: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 556 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 461 |
| Total of all active and inactive participants | 2011-04-01 | 461 |
| 2010: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-04-01 | 706 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 556 |
| Number of retired or separated participants receiving benefits | 2010-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-04-01 | 0 |
| Total of all active and inactive participants | 2010-04-01 | 556 |
| 2009: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 541 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 489 |
| Total of all active and inactive participants | 2009-04-01 | 489 |
| Total participants | 2009-04-01 | 0 |
| 2022: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Submission has been amended | No |
| 2022-04-01 | This submission is the final filing | No |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-01 | Plan is a collectively bargained plan | No |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Submission has been amended | No |
| 2021-04-01 | This submission is the final filing | No |
| 2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-04-01 | Plan is a collectively bargained plan | No |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Submission has been amended | No |
| 2020-04-01 | This submission is the final filing | No |
| 2020-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-04-01 | Plan is a collectively bargained plan | No |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Submission has been amended | No |
| 2019-04-01 | This submission is the final filing | No |
| 2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-04-01 | Plan is a collectively bargained plan | No |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Submission has been amended | No |
| 2018-04-01 | This submission is the final filing | No |
| 2018-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-04-01 | Plan is a collectively bargained plan | No |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Submission has been amended | No |
| 2017-04-01 | This submission is the final filing | No |
| 2017-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-04-01 | Plan is a collectively bargained plan | No |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Submission has been amended | No |
| 2016-04-01 | This submission is the final filing | No |
| 2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-04-01 | Plan is a collectively bargained plan | No |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Submission has been amended | No |
| 2015-04-01 | This submission is the final filing | No |
| 2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-04-01 | Plan is a collectively bargained plan | No |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Submission has been amended | No |
| 2014-04-01 | This submission is the final filing | No |
| 2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-04-01 | Plan is a collectively bargained plan | No |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Submission has been amended | No |
| 2013-04-01 | This submission is the final filing | No |
| 2013-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-04-01 | Plan is a collectively bargained plan | No |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Submission has been amended | No |
| 2012-04-01 | This submission is the final filing | No |
| 2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-04-01 | Plan is a collectively bargained plan | No |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Submission has been amended | No |
| 2011-04-01 | This submission is the final filing | No |
| 2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-04-01 | Plan is a collectively bargained plan | No |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2010 form 5500 responses |
|---|
| 2010-04-01 | Type of plan entity | Single employer plan |
| 2010-04-01 | Submission has been amended | No |
| 2010-04-01 | This submission is the final filing | No |
| 2010-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-04-01 | Plan is a collectively bargained plan | No |
| 2010-04-01 | Plan funding arrangement – Insurance | Yes |
| 2010-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS 2009 form 5500 responses |
|---|
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | Submission has been amended | No |
| 2009-04-01 | This submission is the final filing | No |
| 2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-04-01 | Plan is a collectively bargained plan | No |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $4,869 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | 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 | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $32,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,869 | | Insurance broker organization code? | 3 |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $5,088 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $33,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,088 | | Insurance broker organization code? | 3 |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 396 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $5,375 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $35,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,375 | | Insurance broker organization code? | 3 |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 406 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $5,645 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $37,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,645 | | Insurance broker organization code? | 3 |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 429 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $5,677 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $37,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,677 | | Insurance broker organization code? | 3 |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 413 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $5,631 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $37,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,631 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 424 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $5,527 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $36,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,527 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $5,716 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $38,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,716 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 435 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $5,829 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $38,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,829 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS & YERGER INSURANCE, INC. |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU 5091149 |
| Policy instance | 1 |
| Insurance contract or identification number | GTU 5091149 | | Number of Individuals Covered | 444 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $5,861 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,861 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INSURANCE, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 0CLIGSR10604 |
| Policy instance | 1 |
| Insurance contract or identification number | 0CLIGSR10604 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $5,876 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,177 | | 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 | 0CLIGSR10604 |
| Policy instance | 1 |
| Insurance contract or identification number | 0CLIGSR10604 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $5,760 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $38,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,760 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSS AND YERGER INC. |
|
