CLUB CHAMPION, LLC has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: CLUB CHAMPION HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-12-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-12-01 | 268 |
| Number of retired or separated participants receiving benefits | 2022-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-12-01 | 0 |
| Total of all active and inactive participants | 2022-12-01 | 268 |
| Number of employers contributing to the scheme | 2022-12-01 | 0 |
| 2021: CLUB CHAMPION HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 268 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 268 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
| Total of all active and inactive participants | 2021-12-01 | 268 |
| Number of employers contributing to the scheme | 2021-12-01 | 0 |
| 2020: CLUB CHAMPION HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 126 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
| Total of all active and inactive participants | 2020-12-01 | 126 |
| Number of employers contributing to the scheme | 2020-12-01 | 0 |
| 2019: CLUB CHAMPION HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 229 |
| Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
| Total of all active and inactive participants | 2019-12-01 | 229 |
| Number of employers contributing to the scheme | 2019-12-01 | 0 |
| 2018: CLUB CHAMPION HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 156 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
| Total of all active and inactive participants | 2018-12-01 | 156 |
| Number of employers contributing to the scheme | 2018-12-01 | 0 |
| 2022: CLUB CHAMPION HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: CLUB CHAMPION HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: CLUB CHAMPION HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: CLUB CHAMPION HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: CLUB CHAMPION HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | First time form 5500 has been submitted | Yes |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B65298 |
| Policy instance | 1 |
| Insurance contract or identification number | B65298 | | Number of Individuals Covered | 368 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,078 | | Total amount of fees paid to insurance company | USD $4,441 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $170,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,078 | | Amount paid for insurance broker fees | 4441 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B65298 |
| Policy instance | 1 |
| Insurance contract or identification number | B65298 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $75,573 | | Total amount of fees paid to insurance company | USD $4,875 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,969,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $75,573 | | Amount paid for insurance broker fees | 4875 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B65298 |
| Policy instance | 1 |
| Insurance contract or identification number | B65298 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $53,900 | | Total amount of fees paid to insurance company | USD $4,075 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,305,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $53,900 | | Amount paid for insurance broker fees | 4075 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B65298 |
| Policy instance | 1 |
| Insurance contract or identification number | B65298 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $35,686 | | Total amount of fees paid to insurance company | USD $2,625 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $904,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $35,686 | | Amount paid for insurance broker fees | 2625 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 665298 |
| Policy instance | 1 |
| Insurance contract or identification number | 665298 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $32,523 | | Total amount of fees paid to insurance company | USD $378 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $804,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,523 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS |
|
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