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PORT-A-COOL, LLC INSURANCE PLAN 401k Plan overview

Plan NamePORT-A-COOL, LLC INSURANCE PLAN
Plan identification number 501

PORT-A-COOL, LLC INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

PORT-A-COOL, LLC has sponsored the creation of one or more 401k plans.

Company Name:PORT-A-COOL, LLC
Employer identification number (EIN):205726218
NAIC Classification:335900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORT-A-COOL, LLC INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01ASHTON KENNEY2023-07-10
5012021-01-01ASHTON KENNEY2022-07-12
5012020-01-01ASHTON KENNEY2021-10-14
5012019-01-01ASHTON KENNEY2020-08-26
5012018-01-01ASHTON BROWN2019-10-14
5012017-01-01ROB KENNEDY
5012016-01-01ROB KENNEDY
5012015-01-01ROB KENNEDY
5012014-01-01ROB KENNEDY
5012013-01-01ROB KENNEDY
5012012-01-01ROB KENNEDY
5012011-01-01ROB KENNEDY
5012010-01-01ROB KENNEDY
5012009-01-01ERNESTO GUILLEN

Plan Statistics for PORT-A-COOL, LLC INSURANCE PLAN

401k plan membership statisitcs for PORT-A-COOL, LLC INSURANCE PLAN

Measure Date Value
2022: PORT-A-COOL, LLC INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01468
Total number of active participants reported on line 7a of the Form 55002022-01-01472
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01472
2021: PORT-A-COOL, LLC INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01477
Total number of active participants reported on line 7a of the Form 55002021-01-01468
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01468
2020: PORT-A-COOL, LLC INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01480
Total number of active participants reported on line 7a of the Form 55002020-01-01477
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01477
2019: PORT-A-COOL, LLC INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01487
Total number of active participants reported on line 7a of the Form 55002019-01-01480
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01480
2018: PORT-A-COOL, LLC INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01484
Total number of active participants reported on line 7a of the Form 55002018-01-01487
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01487
2017: PORT-A-COOL, LLC INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01474
Total number of active participants reported on line 7a of the Form 55002017-01-01484
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01484
2016: PORT-A-COOL, LLC INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01464
Total number of active participants reported on line 7a of the Form 55002016-01-01474
Total of all active and inactive participants2016-01-01474
Total participants2016-01-01474
2015: PORT-A-COOL, LLC INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01419
Total number of active participants reported on line 7a of the Form 55002015-01-01464
Total of all active and inactive participants2015-01-01464
Total participants2015-01-010
2014: PORT-A-COOL, LLC INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01398
Total number of active participants reported on line 7a of the Form 55002014-01-01419
Total of all active and inactive participants2014-01-01419
Total participants2014-01-010
2013: PORT-A-COOL, LLC INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01324
Total number of active participants reported on line 7a of the Form 55002013-01-01398
Total of all active and inactive participants2013-01-01398
Total participants2013-01-010
2012: PORT-A-COOL, LLC INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01226
Total number of active participants reported on line 7a of the Form 55002012-01-01324
Total of all active and inactive participants2012-01-01324
Total participants2012-01-010
2011: PORT-A-COOL, LLC INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01226
Total number of active participants reported on line 7a of the Form 55002011-01-01300
Total of all active and inactive participants2011-01-01300
Total participants2011-01-01300
2010: PORT-A-COOL, LLC INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01160
Total number of active participants reported on line 7a of the Form 55002010-01-01226
Total of all active and inactive participants2010-01-01226
Total participants2010-01-01226
2009: PORT-A-COOL, LLC INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01160
Total number of active participants reported on line 7a of the Form 55002009-01-01160
Total of all active and inactive participants2009-01-01160
Total participants2009-01-01160

Form 5500 Responses for PORT-A-COOL, LLC INSURANCE PLAN

2022: PORT-A-COOL, LLC INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: PORT-A-COOL, LLC INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: PORT-A-COOL, LLC INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: PORT-A-COOL, LLC INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: PORT-A-COOL, LLC INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: PORT-A-COOL, LLC INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: PORT-A-COOL, LLC INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: PORT-A-COOL, LLC INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: PORT-A-COOL, LLC INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: PORT-A-COOL, LLC INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: PORT-A-COOL, LLC INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: PORT-A-COOL, LLC INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: PORT-A-COOL, LLC INSURANCE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: PORT-A-COOL, LLC INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered472
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $49,367
Total amount of fees paid to insurance companyUSD $4,305
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $481,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,905
Amount paid for insurance broker fees4305
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number010940
Policy instance 6
Insurance contract or identification number010940
Number of Individuals Covered461
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $15,223
Total amount of fees paid to insurance companyUSD $4,305
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,223
Amount paid for insurance broker fees4305
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered100
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Other welfare benefits providedFSA/DCA
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number36668
Policy instance 3
Insurance contract or identification number36668
Number of Individuals Covered386
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,343
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,343
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered258
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,709
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,011
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B94X
Policy instance 5
Insurance contract or identification numberG000B94X
Number of Individuals Covered410
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $24,267
Total amount of fees paid to insurance companyUSD $8,109
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $161,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,267
Amount paid for insurance broker fees8109
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered81
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Other welfare benefits providedFSA/DCA
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered241
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,553
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,553
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B94X
Policy instance 5
Insurance contract or identification numberG000B94X
Number of Individuals Covered274
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $26,531
Total amount of fees paid to insurance companyUSD $8,001
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,531
Amount paid for insurance broker fees8001
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number010940
Policy instance 6
Insurance contract or identification number010940
Number of Individuals Covered472
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $16,293
Total amount of fees paid to insurance companyUSD $6,715
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $167,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,293
Amount paid for insurance broker fees6715
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered468
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $50,090
Total amount of fees paid to insurance companyUSD $6,715
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $462,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,533
Amount paid for insurance broker fees6715
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number136298
Policy instance 3
Insurance contract or identification number136298
Number of Individuals Covered513
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,517
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,517
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered253
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,828
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,828
TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )
Policy contract number136298
Policy instance 3
Insurance contract or identification number136298
Number of Individuals Covered384
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $17,184
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 number010940
Policy instance 6
Insurance contract or identification number010940
Number of Individuals Covered498
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,989
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,989
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered97
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Other welfare benefits providedFSA/DCA
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 number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered477
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $51,049
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $439,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,367
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B94X
Policy instance 5
Insurance contract or identification numberG000B94X
Number of Individuals Covered360
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $24,004
Total amount of fees paid to insurance companyUSD $5,340
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $160,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,004
Amount paid for insurance broker fees5340
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered458
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $45,093
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $426,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,093
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number010940
Policy instance 6
Insurance contract or identification number010940
Number of Individuals Covered480
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,683
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,683
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B94X
Policy instance 5
Insurance contract or identification numberG000B94X
Number of Individuals Covered341
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $22,886
Total amount of fees paid to insurance companyUSD $6,245
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $152,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,886
Amount paid for insurance broker fees6245
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered89
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,517
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,517
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered74
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Other welfare benefits providedFSA/DCA
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: 39616 )
Policy contract number30011696
Policy instance 3
Insurance contract or identification number30011696
Number of Individuals Covered162
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,469
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,469
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30011696
Policy instance 3
Insurance contract or identification number30011696
Number of Individuals Covered139
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,471
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,471
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B94X
Policy instance 5
Insurance contract or identification numberG000B94X
Number of Individuals Covered330
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $21,972
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $146,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,972
Insurance broker organization code?3
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered93
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Other welfare benefits providedFSA/DCA
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 number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered463
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $40,123
Total amount of fees paid to insurance companyUSD $2,875
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $369,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,443
Amount paid for insurance broker fees2871
Additional information about fees paid to insurance brokerMISC
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered179
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,004
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,004
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number010940
Policy instance 6
Insurance contract or identification number010940
Number of Individuals Covered487
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $16,027
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $164,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,617
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 1
Insurance contract or identification number10940
Number of Individuals Covered496
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $41,246
Total amount of fees paid to insurance companyUSD $2,045
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $369,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,566
Amount paid for insurance broker fees2029
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS / MISC
Insurance broker organization code?3
Insurance broker namePORTACOOL LLC
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberPOR
Policy instance 2
Insurance contract or identification numberPOR
Number of Individuals Covered86
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Other welfare benefits providedFSA/DCA
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: 39616 )
Policy contract number30011696
Policy instance 3
Insurance contract or identification number30011696
Number of Individuals Covered162
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,561
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,473
Insurance broker organization code?3
Insurance broker nameHIGGINBOTHAM INSURANCE AGENCY
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 4
Insurance contract or identification number29513
Number of Individuals Covered123
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,226
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,226
Insurance broker nameUSI INSURANCE SERVICES NATIONAL INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014510
Policy instance 5
Insurance contract or identification numberF014510
Number of Individuals Covered332
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $25,654
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD, ADDSUP1,C,S, DEPSUBC,S, LIFESU
Welfare Benefit Premiums Paid to CarrierUSD $161,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,626
Insurance broker nameHIGGINBOTHAM INSURANCE AGENCY INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 3
Insurance contract or identification number10940
Number of Individuals Covered464
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $40,025
Total amount of fees paid to insurance companyUSD $3,240
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $292,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,025
Amount paid for insurance broker fees3240
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 4
Insurance contract or identification number000010123229
Number of Individuals Covered336
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,298
Total amount of fees paid to insurance companyUSD $1,731
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $41,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,298
Insurance broker organization code?3
Amount paid for insurance broker fees1731
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 5
Insurance contract or identification number000010096571
Number of Individuals Covered339
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,546
Total amount of fees paid to insurance companyUSD $1,584
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $36,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,546
Insurance broker organization code?3
Amount paid for insurance broker fees1584
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096572
Policy instance 6
Insurance contract or identification number000010096572
Number of Individuals Covered339
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,982
Total amount of fees paid to insurance companyUSD $1,929
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,982
Insurance broker organization code?3
Amount paid for insurance broker fees1929
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D015699
Policy instance 7
Insurance contract or identification number00001D015699
Number of Individuals Covered275
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $15,787
Total amount of fees paid to insurance companyUSD $2,940
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $157,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,787
Insurance broker organization code?3
Amount paid for insurance broker fees2940
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30011696
Policy instance 2
Insurance contract or identification number30011696
Number of Individuals Covered142
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,367
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,367
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000143
Policy instance 1
Insurance contract or identification number00040F001000143
Number of Individuals Covered114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,428
Total amount of fees paid to insurance companyUSD $1,637
Other welfare benefits providedVOLUNTARY AD&D, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $42,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,428
Insurance broker organization code?3
Amount paid for insurance broker fees1637
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 4
Insurance contract or identification number000010123229
Number of Individuals Covered304
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,110
Total amount of fees paid to insurance companyUSD $1,458
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $40,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,110
Insurance broker organization code?3
Amount paid for insurance broker fees1458
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 5
Insurance contract or identification number000010096571
Number of Individuals Covered306
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,592
Total amount of fees paid to insurance companyUSD $1,261
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $37,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,592
Insurance broker organization code?3
Amount paid for insurance broker fees1261
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000143
Policy instance 1
Insurance contract or identification number00040F001000143
Number of Individuals Covered95
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,777
Total amount of fees paid to insurance companyUSD $1,331
Other welfare benefits providedVOLUNTARY AD&D, VOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $38,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,777
Insurance broker organization code?3
Amount paid for insurance broker fees1331
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 3
Insurance contract or identification number10940
Number of Individuals Covered419
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,730
Total amount of fees paid to insurance companyUSD $2,538
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $243,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,730
Amount paid for insurance broker fees2538
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D015699
Policy instance 7
Insurance contract or identification number00001D015699
Number of Individuals Covered253
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $13,837
Total amount of fees paid to insurance companyUSD $1,146
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,837
Insurance broker organization code?3
Amount paid for insurance broker fees1146
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096572
Policy instance 6
Insurance contract or identification number000010096572
Number of Individuals Covered304
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,809
Total amount of fees paid to insurance companyUSD $1,559
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,809
Insurance broker organization code?3
Amount paid for insurance broker fees1559
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30011696
Policy instance 2
Insurance contract or identification number30011696
Number of Individuals Covered111
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,105
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,105
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 5
Insurance contract or identification number000010096571
Number of Individuals Covered275
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,450
Total amount of fees paid to insurance companyUSD $355
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $29,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,450
Insurance broker organization code?3
Amount paid for insurance broker fees355
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000143
Policy instance 1
Insurance contract or identification number00040F001000143
Number of Individuals Covered87
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,697
Total amount of fees paid to insurance companyUSD $385
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,697
Insurance broker organization code?3
Amount paid for insurance broker fees385
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30011696
Policy instance 2
Insurance contract or identification number30011696
Number of Individuals Covered108
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,572
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 number10940
Policy instance 3
Insurance contract or identification number10940
Number of Individuals Covered398
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $34,629
Total amount of fees paid to insurance companyUSD $2,988
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $283,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,629
Amount paid for insurance broker fees2988
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 4
Insurance contract or identification number000010123229
Number of Individuals Covered274
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,144
Total amount of fees paid to insurance companyUSD $403
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $34,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,144
Insurance broker organization code?3
Amount paid for insurance broker fees403
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 6
Insurance contract or identification number29513
Number of Individuals Covered58
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $664
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $664
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D015699
Policy instance 8
Insurance contract or identification number00001D015699
Number of Individuals Covered215
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,785
Total amount of fees paid to insurance companyUSD $306
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,785
Insurance broker organization code?3
Amount paid for insurance broker fees306
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096572
Policy instance 7
Insurance contract or identification number000010096572
Number of Individuals Covered274
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,504
Total amount of fees paid to insurance companyUSD $438
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,504
Insurance broker organization code?3
Amount paid for insurance broker fees438
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameWELLS FARGO INS SVCS USA INC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 1
Insurance contract or identification number29513
Number of Individuals Covered57
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $548
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $548
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000143
Policy instance 6
Insurance contract or identification number00040F001000143
Number of Individuals Covered217
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,624
Total amount of fees paid to insurance companyUSD $955
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees955
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $4,624
Insurance broker nameWELLS FARGO INS SVCS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30011696
Policy instance 5
Insurance contract or identification number30011696
Number of Individuals Covered77
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $999
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $999
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number10940
Policy instance 4
Insurance contract or identification number10940
Number of Individuals Covered324
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $32,940
Total amount of fees paid to insurance companyUSD $2,748
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $257,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,940
Amount paid for insurance broker fees2748
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 2
Insurance contract or identification number000010096571
Number of Individuals Covered270
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,258
Total amount of fees paid to insurance companyUSD $687
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $28,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees687
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $4,258
Insurance broker nameWELLS FARGO INS SVCS USA INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 3
Insurance contract or identification number000010123229
Number of Individuals Covered268
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,839
Total amount of fees paid to insurance companyUSD $740
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $32,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees740
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $4,839
Insurance broker nameWELLS FARGO INS SVCS USA INC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 1
Insurance contract or identification number29513
Number of Individuals Covered46
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $397
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000
Policy instance 2
Insurance contract or identification number00040F001000
Number of Individuals Covered230
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,881
Other welfare benefits providedVOL LIFE, VOL AD&D, CHILD & SPOUSE
Welfare Benefit Premiums Paid to CarrierUSD $32,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 3
Insurance contract or identification number000010123229
Number of Individuals Covered263
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,783
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $25,222
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 number10940
Policy instance 6
Insurance contract or identification number10940
Number of Individuals Covered300
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $26,280
Total amount of fees paid to insurance companyUSD $2,028
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,956
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: 39616 )
Policy contract number30011696
Policy instance 7
Insurance contract or identification number30011696
Number of Individuals Covered72
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $860
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D015699
Policy instance 8
Insurance contract or identification number00001D015699
Number of Individuals Covered209
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,286
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096572
Policy instance 4
Insurance contract or identification number000010096572
Number of Individuals Covered266
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,142
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 5
Insurance contract or identification number000010096571
Number of Individuals Covered265
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,511
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $23,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number29513
Policy instance 1
Insurance contract or identification number29513
Number of Individuals Covered14
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $292
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00040F001000
Policy instance 2
Insurance contract or identification number00040F001000
Number of Individuals Covered210
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,865
Total amount of fees paid to insurance companyUSD $411
Other welfare benefits providedVOL LIFE, VOL AD&D, CHILD & SPOUSE
Welfare Benefit Premiums Paid to CarrierUSD $32,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096572
Policy instance 4
Insurance contract or identification number000010096572
Number of Individuals Covered179
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,542
Total amount of fees paid to insurance companyUSD $202
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010096571
Policy instance 5
Insurance contract or identification number000010096571
Number of Individuals Covered177
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,159
Total amount of fees paid to insurance companyUSD $286
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $21,062
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 number10940
Policy instance 6
Insurance contract or identification number10940
Number of Individuals Covered226
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $21,102
Total amount of fees paid to insurance companyUSD $1,848
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,636
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: 39616 )
Policy contract number30011696
Policy instance 7
Insurance contract or identification number30011696
Number of Individuals Covered45
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $643
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00001D015699
Policy instance 8
Insurance contract or identification number00001D015699
Number of Individuals Covered141
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,743
Total amount of fees paid to insurance companyUSD $268
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010123229
Policy instance 3
Insurance contract or identification number000010123229
Number of Individuals Covered175
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,494
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $23,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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