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CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan NameCHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN
Plan identification number 501

CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CHEROKEE NATION BUSINESSES, LLC has sponsored the creation of one or more 401k plans.

Company Name:CHEROKEE NATION BUSINESSES, LLC
Employer identification number (EIN):113784371
NAIC Classification:713900

Additional information about CHEROKEE NATION BUSINESSES, LLC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: 201433610072

More information about CHEROKEE NATION BUSINESSES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JOANNE RUTH2023-10-11
5012021-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-05-01ROBIN LACY ROBIN LACY2018-10-05
5012016-05-01ROBIN LACY ROBIN LACY2018-02-14
5012015-05-01ROBIN LACY ROBIN LACY2017-02-15
5012014-05-01SUSIE SEABA SUSIE SEABA2016-02-15
5012013-05-01SUSIE SEABA SUSIE SEABA2015-02-17
5012012-05-01SUSIE SEABA
5012011-05-01SUSIE SCOTT

Plan Statistics for CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN

Measure Date Value
2022: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-013,446
Total number of active participants reported on line 7a of the Form 55002022-01-013,442
Number of retired or separated participants receiving benefits2022-01-0114
Number of other retired or separated participants entitled to future benefits2022-01-0196
Total of all active and inactive participants2022-01-013,552
2021: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-013,435
Total number of active participants reported on line 7a of the Form 55002021-01-013,159
Number of retired or separated participants receiving benefits2021-01-0114
Number of other retired or separated participants entitled to future benefits2021-01-0196
Total of all active and inactive participants2021-01-013,269
2020: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-014,060
Total number of active participants reported on line 7a of the Form 55002020-01-013,301
Number of retired or separated participants receiving benefits2020-01-0115
Number of other retired or separated participants entitled to future benefits2020-01-01119
Total of all active and inactive participants2020-01-013,435
2019: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-014,137
Total number of active participants reported on line 7a of the Form 55002019-01-013,869
Number of retired or separated participants receiving benefits2019-01-018
Number of other retired or separated participants entitled to future benefits2019-01-01183
Total of all active and inactive participants2019-01-014,060
2018: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-013,992
Total number of active participants reported on line 7a of the Form 55002018-01-013,988
Number of retired or separated participants receiving benefits2018-01-018
Number of other retired or separated participants entitled to future benefits2018-01-01141
Total of all active and inactive participants2018-01-014,137
2017: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-019,742
Total number of active participants reported on line 7a of the Form 55002017-05-015,453
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-01354
Total of all active and inactive participants2017-05-015,807
2016: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-0110,021
Total number of active participants reported on line 7a of the Form 55002016-05-019,732
Number of retired or separated participants receiving benefits2016-05-0110
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-019,742
2015: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-015,409
Total number of active participants reported on line 7a of the Form 55002015-05-015,732
Number of retired or separated participants receiving benefits2015-05-0122
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-015,754
2014: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-018,591
Total number of active participants reported on line 7a of the Form 55002014-05-019,816
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-019,816
2013: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-017,933
Total number of active participants reported on line 7a of the Form 55002013-05-018,591
Total of all active and inactive participants2013-05-018,591
2012: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-017,429
Total number of active participants reported on line 7a of the Form 55002012-05-017,933
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-017,933
2011: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-016,441
Total number of active participants reported on line 7a of the Form 55002011-05-017,429
Number of retired or separated participants receiving benefits2011-05-0134
Total of all active and inactive participants2011-05-017,463
Total participants2011-05-017,463

Financial Data on CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN

Measure Date Value
2017 : CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-04-30$62,433,831
Total of all expenses incurred2017-04-30$62,689,729
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-04-30$59,755,920
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-04-30$61,136,592
Value of total assets at end of year2017-04-30$0
Value of total assets at beginning of year2017-04-30$255,898
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-04-30$2,933,809
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-04-30No
Was this plan covered by a fidelity bond2017-04-30Yes
Value of fidelity bond cover2017-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2017-04-30No
Contributions received from participants2017-04-30$7,856,730
Income. Received or receivable in cash from other sources (including rollovers)2017-04-30$175,396
Other income not declared elsewhere2017-04-30$1,297,239
Total non interest bearing cash at end of year2017-04-30$0
Total non interest bearing cash at beginning of year2017-04-30$255,898
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Value of net income/loss2017-04-30$-255,898
Value of net assets at end of year (total assets less liabilities)2017-04-30$0
Value of net assets at beginning of year (total assets less liabilities)2017-04-30$255,898
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-04-30No
Were any leases to which the plan was party in default or uncollectible2017-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-04-30$4,602,732
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-04-30No
Was there a failure to transmit to the plan any participant contributions2017-04-30No
Has the plan failed to provide any benefit when due under the plan2017-04-30No
Contributions received in cash from employer2017-04-30$53,104,466
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-04-30$55,153,188
Contract administrator fees2017-04-30$2,933,809
Did the plan have assets held for investment2017-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-04-30No
Opinion of an independent qualified public accountant for this plan2017-04-30Unqualified
Accountancy firm name2017-04-30BKD, LLP
Accountancy firm EIN2017-04-30440160260
2016 : CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-04-30$61,118,073
Total of all expenses incurred2016-04-30$60,946,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-04-30$58,194,325
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-04-30$59,603,447
Value of total assets at end of year2016-04-30$255,898
Value of total assets at beginning of year2016-04-30$84,520
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-04-30$2,752,370
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-04-30No
Was this plan covered by a fidelity bond2016-04-30Yes
Value of fidelity bond cover2016-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2016-04-30No
Contributions received from participants2016-04-30$8,503,728
Income. Received or receivable in cash from other sources (including rollovers)2016-04-30$210,873
Other income not declared elsewhere2016-04-30$1,514,626
Total non interest bearing cash at end of year2016-04-30$255,898
Total non interest bearing cash at beginning of year2016-04-30$84,520
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Value of net income/loss2016-04-30$171,378
Value of net assets at end of year (total assets less liabilities)2016-04-30$255,898
Value of net assets at beginning of year (total assets less liabilities)2016-04-30$84,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-04-30No
Were any leases to which the plan was party in default or uncollectible2016-04-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-04-30$4,369,678
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-04-30No
Was there a failure to transmit to the plan any participant contributions2016-04-30No
Has the plan failed to provide any benefit when due under the plan2016-04-30No
Contributions received in cash from employer2016-04-30$50,888,846
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-04-30$53,824,647
Contract administrator fees2016-04-30$2,752,370
Did the plan have assets held for investment2016-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-04-30No
Opinion of an independent qualified public accountant for this plan2016-04-30Unqualified
Accountancy firm name2016-04-30BKD, LLP
Accountancy firm EIN2016-04-30440160260
2015 : CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2015 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-04-30$0
Total income from all sources (including contributions)2015-04-30$49,425,568
Total of all expenses incurred2015-04-30$49,499,380
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-04-30$46,959,089
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-04-30$48,796,259
Value of total assets at end of year2015-04-30$84,520
Value of total assets at beginning of year2015-04-30$158,332
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-04-30$2,540,291
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-04-30No
Assets. Real estate other than employer real property at beginning of year2015-04-30$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2015-04-30$0
Was this plan covered by a fidelity bond2015-04-30Yes
Value of fidelity bond cover2015-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-04-30No
Contributions received from participants2015-04-30$6,963,614
Participant contributions at beginning of year2015-04-30$0
Participant contributions at beginning of year2015-04-30$0
Income. Received or receivable in cash from other sources (including rollovers)2015-04-30$114,758
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-04-30$0
Assets. Loans (other than to participants) at beginning of year2015-04-30$0
Other income not declared elsewhere2015-04-30$629,309
Total non interest bearing cash at end of year2015-04-30$84,520
Total non interest bearing cash at beginning of year2015-04-30$158,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Value of net income/loss2015-04-30$-73,812
Value of net assets at end of year (total assets less liabilities)2015-04-30$84,520
Value of net assets at beginning of year (total assets less liabilities)2015-04-30$158,332
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-04-30No
Were any leases to which the plan was party in default or uncollectible2015-04-30No
Assets. partnership/joint venture interests at beginning of year2015-04-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-04-30$0
Value of interest in pooled separate accounts at beginning of year2015-04-30$0
Value of interest in master investment trust accounts at beginning of year2015-04-30$0
Value of interest in common/collective trusts at beginning of year2015-04-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-04-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-04-30$0
Assets. Value of investments in 103.12 investment entities at beginning of year2015-04-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2015-04-30$4,585,459
Asset value of US Government securities at beginning of year2015-04-30$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-04-30No
Was there a failure to transmit to the plan any participant contributions2015-04-30No
Has the plan failed to provide any benefit when due under the plan2015-04-30No
Contributions received in cash from employer2015-04-30$41,717,887
Employer contributions (assets) at beginning of year2015-04-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-04-30$42,373,630
Asset. Corporate debt instrument preferred debt at beginning of year2015-04-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2015-04-30$0
Contract administrator fees2015-04-30$2,540,291
Assets. Corporate common stocks other than exployer securities at beginning of year2015-04-30$0
Liabilities. Value of benefit claims payable at beginning of year2015-04-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-04-30$0
Did the plan have assets held for investment2015-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-04-30No
Opinion of an independent qualified public accountant for this plan2015-04-30Unqualified
Accountancy firm name2015-04-30BKD, LLP
Accountancy firm EIN2015-04-30440160260
2014 : CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$0
Total income from all sources (including contributions)2014-04-30$43,559,134
Total of all expenses incurred2014-04-30$43,400,802
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-04-30$39,838,906
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-04-30$43,380,214
Value of total assets at end of year2014-04-30$158,332
Value of total assets at beginning of year2014-04-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-04-30$3,561,896
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-04-30No
Assets. Real estate other than employer real property at end of year2014-04-30$0
Assets. Real estate other than employer real property at beginning of year2014-04-30$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2014-04-30$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2014-04-30$0
Was this plan covered by a fidelity bond2014-04-30Yes
Value of fidelity bond cover2014-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-04-30No
Contributions received from participants2014-04-30$6,431,468
Participant contributions at end of year2014-04-30$0
Participant contributions at beginning of year2014-04-30$0
Participant contributions at end of year2014-04-30$0
Participant contributions at beginning of year2014-04-30$0
Income. Received or receivable in cash from other sources (including rollovers)2014-04-30$158,856
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-04-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-04-30$0
Assets. Loans (other than to participants) at end of year2014-04-30$0
Assets. Loans (other than to participants) at beginning of year2014-04-30$0
Other income not declared elsewhere2014-04-30$178,920
Total non interest bearing cash at end of year2014-04-30$158,332
Total non interest bearing cash at beginning of year2014-04-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Value of net income/loss2014-04-30$158,332
Value of net assets at end of year (total assets less liabilities)2014-04-30$158,332
Value of net assets at beginning of year (total assets less liabilities)2014-04-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-04-30No
Were any leases to which the plan was party in default or uncollectible2014-04-30No
Assets. partnership/joint venture interests at end of year2014-04-30$0
Assets. partnership/joint venture interests at beginning of year2014-04-30$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-04-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-04-30$0
Value of interest in pooled separate accounts at end of year2014-04-30$0
Value of interest in pooled separate accounts at beginning of year2014-04-30$0
Value of interest in master investment trust accounts at end of year2014-04-30$0
Value of interest in master investment trust accounts at beginning of year2014-04-30$0
Value of interest in common/collective trusts at end of year2014-04-30$0
Value of interest in common/collective trusts at beginning of year2014-04-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-04-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-04-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-04-30$0
Assets. Value of investments in 103.12 investment entities at end of year2014-04-30$0
Assets. Value of investments in 103.12 investment entities at beginning of year2014-04-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-04-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-04-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-04-30$3,352,687
Asset value of US Government securities at end of year2014-04-30$0
Asset value of US Government securities at beginning of year2014-04-30$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-04-30No
Was there a failure to transmit to the plan any participant contributions2014-04-30No
Has the plan failed to provide any benefit when due under the plan2014-04-30No
Contributions received in cash from employer2014-04-30$36,789,890
Employer contributions (assets) at end of year2014-04-30$0
Employer contributions (assets) at beginning of year2014-04-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-04-30$36,486,219
Asset. Corporate debt instrument preferred debt at end of year2014-04-30$0
Asset. Corporate debt instrument preferred debt at beginning of year2014-04-30$0
Asset. Corporate debt instrument debt (other) at end of year2014-04-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2014-04-30$0
Contract administrator fees2014-04-30$3,561,896
Assets. Corporate common stocks other than exployer securities at end of year2014-04-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2014-04-30$0
Liabilities. Value of benefit claims payable at end of year2014-04-30$0
Liabilities. Value of benefit claims payable at beginning of year2014-04-30$0
Assets. Value of buildings and other operty used in plan operation at end of year2014-04-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-04-30$0
Did the plan have assets held for investment2014-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-04-30No
Opinion of an independent qualified public accountant for this plan2014-04-30Unqualified
Accountancy firm name2014-04-30BKD, LLP
Accountancy firm EIN2014-04-30440160260

Form 5500 Responses for CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN

2022: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – General assets of the sponsorYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – General assets of the sponsorYes
2016: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – TrustYes
2016-05-01Plan funding arrangement – General assets of the sponsorYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement - TrustYes
2016-05-01Plan benefit arrangement – General assets of the sponsorYes
2015: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes
2014: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement - TrustYes
2013: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – TrustYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement - TrustYes
2012: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – General assets of the sponsorYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – General assets of the sponsorYes
2011: CHEROKEE NATION BUSINESSES, LLC HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – General assets of the sponsorYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0000163785
Policy instance 2
Insurance contract or identification number0000163785
Number of Individuals Covered145
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $56,819
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $216,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,303
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30040115
Policy instance 1
Insurance contract or identification number30040115
Number of Individuals Covered4599
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
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 number426941
Policy instance 3
Insurance contract or identification number426941
Number of Individuals Covered3196
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,725
Total amount of fees paid to insurance companyUSD $40,173
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $436,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,725
Amount paid for insurance broker fees40173
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30040115
Policy instance 2
Insurance contract or identification number30040115
Number of Individuals Covered1798
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
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 number426942
Policy instance 1
Insurance contract or identification number426942
Number of Individuals Covered3196
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22,905
Total amount of fees paid to insurance companyUSD $14,315
Life Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $1,145,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,905
Amount paid for insurance broker fees14315
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00489352
Policy instance 1
Insurance contract or identification number00489352
Number of Individuals Covered1247
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $36,161
Total amount of fees paid to insurance companyUSD $12,414
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $401,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,161
Amount paid for insurance broker fees12414
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 968200
Policy instance 2
Insurance contract or identification numberOK 968200
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,560
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $78,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,560
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966678
Policy instance 3
Insurance contract or identification numberFLX966678
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $20,508
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,025,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,508
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 964591
Policy instance 4
Insurance contract or identification numberLK 964591
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,142
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $457,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,142
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30040115
Policy instance 5
Insurance contract or identification number30040115
Number of Individuals Covered4118
Insurance policy start date2017-05-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
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 number0149359
Policy instance 6
Insurance contract or identification number0149359
Number of Individuals Covered0
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $10,055
Total amount of fees paid to insurance companyUSD $11,463
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,055
Amount paid for insurance broker fees11463
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF OKLAHOMA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30040115
Policy instance 5
Insurance contract or identification number30040115
Number of Individuals Covered3831
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 964591
Policy instance 4
Insurance contract or identification numberLK 964591
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $11,322
Total amount of fees paid to insurance companyUSD $14,275
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $566,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,322
Amount paid for insurance broker fees14275
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966678
Policy instance 3
Insurance contract or identification numberFLX966678
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $24,073
Total amount of fees paid to insurance companyUSD $22,500
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,203,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,073
Amount paid for insurance broker fees22500
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 968200
Policy instance 2
Insurance contract or identification numberOK 968200
Number of Individuals Covered5732
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $1,883
Total amount of fees paid to insurance companyUSD $2,390
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $94,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,883
Amount paid for insurance broker fees2390
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF OKLAHOMA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00489352
Policy instance 1
Insurance contract or identification number00489352
Number of Individuals Covered1449
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $27,567
Total amount of fees paid to insurance companyUSD $12,358
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,567
Amount paid for insurance broker fees12358
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number230478
Policy instance 5
Insurance contract or identification number230478
Number of Individuals Covered4178
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $24,889
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,491,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,889
Insurance broker organization code?3
Insurance broker nameSTHEALTH BENEFIT SOLUTIONS LLC DBA
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0149359
Policy instance 4
Insurance contract or identification number0149359
Number of Individuals Covered8440
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $32,441
Total amount of fees paid to insurance companyUSD $2,279
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $2,147,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,441
Amount paid for insurance broker fees2279
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN LONE STAR INSURANCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30040115
Policy instance 3
Insurance contract or identification number30040115
Number of Individuals Covered3509
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberGFZ02784
Policy instance 2
Insurance contract or identification numberGFZ02784
Number of Individuals Covered3376
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00489352
Policy instance 1
Insurance contract or identification number00489352
Number of Individuals Covered1295
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $28,800
Total amount of fees paid to insurance companyUSD $13,447
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $319,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,800
Amount paid for insurance broker fees13447
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberGFZ02784
Policy instance 2
Insurance contract or identification numberGFZ02784
Number of Individuals Covered3120
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0002B447
Policy instance 1
Insurance contract or identification number0002B447
Number of Individuals Covered1193
Insurance policy start date2013-07-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $19,782
Total amount of fees paid to insurance companyUSD $4,770
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $219,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,782
Amount paid for insurance broker fees4770
Additional information about fees paid to insurance brokerNEW BUSINESS
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract numberK100970
Policy instance 3
Insurance contract or identification numberK100970
Number of Individuals Covered1055
Insurance policy start date2013-05-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $5,826
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,826
Insurance broker organization code?3
Insurance broker nameKANAWHA INSURANCE COMPANY
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYN9799
Policy instance 4
Insurance contract or identification numberYN9799
Number of Individuals Covered9359
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number30040115
Policy instance 5
Insurance contract or identification number30040115
Number of Individuals Covered2993
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0149359
Policy instance 6
Insurance contract or identification number0149359
Number of Individuals Covered7843
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $33,105
Total amount of fees paid to insurance companyUSD $43,790
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,903,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,105
Amount paid for insurance broker fees43790
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN LONE STAR INSURANCE
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYN9799
Policy instance 7
Insurance contract or identification numberYN9799
Number of Individuals Covered8591
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract numberK100970
Policy instance 3
Insurance contract or identification numberK100970
Number of Individuals Covered1055
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $16,452
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $191,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,452
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number149359-01
Policy instance 2
Insurance contract or identification number149359-01
Number of Individuals Covered7300
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $21,881
Total amount of fees paid to insurance companyUSD $35,434
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD & D
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 CarrierUSD $1,755,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,539
Amount paid for insurance broker fees35434
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameJOHN MCMAHAN
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYN9799
Policy instance 1
Insurance contract or identification numberYN9799
Number of Individuals Covered7933
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,275,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number49285
Policy instance 2
Insurance contract or identification number49285
Number of Individuals Covered4156
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $121,766
Total amount of fees paid to insurance companyUSD $1,515
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,305,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberYN9799
Policy instance 1
Insurance contract or identification numberYN9799
Number of Individuals Covered7335
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $992,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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