401k Plan data: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 plan

HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 401k Plan overview

Plan Name	HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501
Plan identification number	501

HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 Benefits

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

401k Sponsoring company profile

HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC has sponsored the creation of one or more 401k plans.

Company Name: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC

Employer identification number (EIN): 262876885

NAIC Classification: 336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 JASON RANSBOTTOM
501 2016-01-01 JASON RANSBOTTOM
501 2015-01-01 JASON RANSBOTTOM
501 2014-01-01 JASON RANSBOTTOM
501 2013-01-01 JASON RANSBOTTOM
501 2012-02-01 JASON RANSBOTTOM
501 2011-02-01 JASON RANSBOTTOM

Plan Statistics for HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501

401k plan membership statisitcs for HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501

Measure Date Value
2022: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2022 401k membership
Total participants, beginning-of-year 2022-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 376
Total of all active and inactive participants 2022-01-01 376
Total participants 2022-01-01 376
2021: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2021 401k membership
Total participants, beginning-of-year 2021-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 286
Total of all active and inactive participants 2021-01-01 286
Total participants 2021-01-01 286
2020: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2020 401k membership
Total participants, beginning-of-year 2020-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 269
Total of all active and inactive participants 2020-01-01 269
Total participants 2020-01-01 269
2019: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2019 401k membership
Total participants, beginning-of-year 2019-01-01 327
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 286
Total of all active and inactive participants 2019-01-01 286
Total participants 2019-01-01 286
Number of participants with account balances 2019-01-01 0
2018: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2018 401k membership
Total participants, beginning-of-year 2018-01-01 379
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 327
Total of all active and inactive participants 2018-01-01 327
Total participants 2018-01-01 327
2017: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2017 401k membership
Total participants, beginning-of-year 2017-01-01 376
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 379
Total of all active and inactive participants 2017-01-01 379
Total participants 2017-01-01 379
2016: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2016 401k membership
Total participants, beginning-of-year 2016-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 376
Total of all active and inactive participants 2016-01-01 376
Total participants 2016-01-01 376
2015: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2015 401k membership
Total participants, beginning-of-year 2015-01-01 337
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 361
Total of all active and inactive participants 2015-01-01 361
Total participants 2015-01-01 0
2014: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2014 401k membership
Total participants, beginning-of-year 2014-01-01 349
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 337
Total of all active and inactive participants 2014-01-01 337
Total participants 2014-01-01 0
2013: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2013 401k membership
Total participants, beginning-of-year 2013-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 347
Total of all active and inactive participants 2013-01-01 347
Total participants 2013-01-01 0
2012: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2012 401k membership
Total participants, beginning-of-year 2012-02-01 195
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 179
Total of all active and inactive participants 2012-02-01 179
Total participants 2012-02-01 0
2011: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2011 401k membership
Total participants, beginning-of-year 2011-02-01 113
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 195
Total of all active and inactive participants 2011-02-01 195
Total participants 2011-02-01 195

Measure	Date	Value
2022: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2022 401k membership
Total participants, beginning-of-year	2022-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	376
Total of all active and inactive participants	2022-01-01	376
Total participants	2022-01-01	376
2021: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2021 401k membership
Total participants, beginning-of-year	2021-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	286
Total of all active and inactive participants	2021-01-01	286
Total participants	2021-01-01	286
2020: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2020 401k membership
Total participants, beginning-of-year	2020-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	269
Total of all active and inactive participants	2020-01-01	269
Total participants	2020-01-01	269
2019: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2019 401k membership
Total participants, beginning-of-year	2019-01-01	327
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	286
Total of all active and inactive participants	2019-01-01	286
Total participants	2019-01-01	286
Number of participants with account balances	2019-01-01	0
2018: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2018 401k membership
Total participants, beginning-of-year	2018-01-01	379
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	327
Total of all active and inactive participants	2018-01-01	327
Total participants	2018-01-01	327
2017: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2017 401k membership
Total participants, beginning-of-year	2017-01-01	376
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	379
Total of all active and inactive participants	2017-01-01	379
Total participants	2017-01-01	379
2016: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2016 401k membership
Total participants, beginning-of-year	2016-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	376
Total of all active and inactive participants	2016-01-01	376
Total participants	2016-01-01	376
2015: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2015 401k membership
Total participants, beginning-of-year	2015-01-01	337
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	361
Total of all active and inactive participants	2015-01-01	361
Total participants	2015-01-01	0
2014: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2014 401k membership
Total participants, beginning-of-year	2014-01-01	349
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	337
Total of all active and inactive participants	2014-01-01	337
Total participants	2014-01-01	0
2013: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2013 401k membership
Total participants, beginning-of-year	2013-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	347
Total of all active and inactive participants	2013-01-01	347
Total participants	2013-01-01	0
2012: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2012 401k membership
Total participants, beginning-of-year	2012-02-01	195
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	179
Total of all active and inactive participants	2012-02-01	179
Total participants	2012-02-01	0
2011: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2011 401k membership
Total participants, beginning-of-year	2011-02-01	113
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	195
Total of all active and inactive participants	2011-02-01	195
Total participants	2011-02-01	195

Form 5500 Responses for HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501

2022: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC EMPLOYEE WELFARE BENEFIT PLAN HEALTH 501 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	803
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $535
Total amount of fees paid to insurance company	USD $90
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $535
Amount paid for insurance broker fees	90
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	824
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,589
Total amount of fees paid to insurance company	USD $601
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $285,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,589
Amount paid for insurance broker fees	601
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	820
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,323
Total amount of fees paid to insurance company	USD $1,394
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $660,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,323
Amount paid for insurance broker fees	1394
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	657
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $458
Total amount of fees paid to insurance company	USD $148
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $458
Amount paid for insurance broker fees	148
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	676
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,121
Total amount of fees paid to insurance company	USD $1,006
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $240,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,121
Amount paid for insurance broker fees	1006
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	672
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,168
Total amount of fees paid to insurance company	USD $2,310
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $552,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,168
Amount paid for insurance broker fees	2310
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	639
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,184
Total amount of fees paid to insurance company	USD $2,389
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $662,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,184
Amount paid for insurance broker fees	2389
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	663
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,612
Total amount of fees paid to insurance company	USD $869
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $240,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,612
Amount paid for insurance broker fees	869
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	641
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $400
Total amount of fees paid to insurance company	USD $133
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $400
Amount paid for insurance broker fees	133
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	666
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,704
Total amount of fees paid to insurance company	USD $11
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,704
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	685
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $32,415
Total amount of fees paid to insurance company	USD $78
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $264,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,415
Amount paid for insurance broker fees	78
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	671
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $42,684
Total amount of fees paid to insurance company	USD $102
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $347,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,684
Amount paid for insurance broker fees	102
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	872
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,461
Total amount of fees paid to insurance company	USD $89
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $982
Amount paid for insurance broker fees	89
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	881
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,306
Total amount of fees paid to insurance company	USD $629
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $337,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,929
Amount paid for insurance broker fees	629
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	872
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $143,013
Total amount of fees paid to insurance company	USD $8,725
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,682,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,864
Insurance broker organization code?	3
Amount paid for insurance broker fees	8725
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker name	J. SMITH LANIER & CO.

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	857
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $162,975
Total amount of fees paid to insurance company	USD $10,817
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,999,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $162,975
Amount paid for insurance broker fees	10817
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3
Insurance broker name	J. SMITH LANIER & CO.

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	865
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,625
Total amount of fees paid to insurance company	USD $838
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $309,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,625
Amount paid for insurance broker fees	838
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8376

Policy instance

Insurance contract or identification number	GA8376
Number of Individuals Covered	845
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,869
Total amount of fees paid to insurance company	USD $124
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,869
Amount paid for insurance broker fees	124
Additional information about fees paid to insurance broker	INCENTIVES,EDUCATION,COMMUNICATION AND TRAINING
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

753116

Policy instance

Insurance contract or identification number	753116
Number of Individuals Covered	864
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $51,335
Total amount of fees paid to insurance company	USD $440,835
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,714,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,335
Amount paid for insurance broker fees	432998
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

753116

Policy instance

Insurance contract or identification number	753116
Number of Individuals Covered	868
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,783
Total amount of fees paid to insurance company	USD $112,113
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,936,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,783
Amount paid for insurance broker fees	108721
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

1047023000

Policy instance

Insurance contract or identification number	1047023000
Number of Individuals Covered	179
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $51,327
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $392,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,327
Insurance broker organization code?	3
Insurance broker name	J. SMITH LANIER & CO.

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA2116

Policy instance

Insurance contract or identification number	GA2116
Number of Individuals Covered	102
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $2,986
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

1047023000

Policy instance

Insurance contract or identification number	1047023000
Number of Individuals Covered	195
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $63,660
Total amount of fees paid to insurance company	USD $1,181
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $991,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA2116

Policy instance

Insurance contract or identification number	GA2116
Number of Individuals Covered	102
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $1,928
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

1047023000

Policy instance

Insurance contract or identification number	1047023000
Number of Individuals Covered	113
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $35,112
Total amount of fees paid to insurance company	USD $1,053
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $643,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HYUNDAI TRANSYS GEORGIA POWERTRAIN, INC
Employer identification number (EIN):	262876885
NAIC Classification:	336300