401k Plan data: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN plan

SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 401k Plan overview

Plan Name	SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN
Plan identification number	501

SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN has sponsored the creation of one or more 401k plans.

Company Name: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

Employer identification number (EIN): 273708085

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2010-10-15

Company Identification Number: 0801331529

Legal Registered Office Address: 9311 SAN PEDRO AVE STE 600

SAN ANTONIO
United States of America (USA)
78216

More information about SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

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 LISA WILSON
501 2016-01-01 LISA WILSON LISA WILSON 2017-10-13
501 2015-01-01 LISA WILSON LISA WILSON 2016-10-14
501 2014-01-01 LISA WILSON LISA WILSON 2015-10-15

Plan id#	Filing Submission Date	Name of Administrator	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	LISA WILSON
501	2016-01-01	LISA WILSON	LISA WILSON	2017-10-13
501	2015-01-01	LISA WILSON	LISA WILSON	2016-10-14
501	2014-01-01	LISA WILSON	LISA WILSON	2015-10-15

Plan Statistics for SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

401k plan membership statisitcs for SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

Measure Date Value
2022: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 11,009
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 13,308
Number of retired or separated participants receiving benefits 2022-01-01 310
Total of all active and inactive participants 2022-01-01 13,618
Total participants 2022-01-01 13,618
2021: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 8,963
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 10,707
Number of retired or separated participants receiving benefits 2021-01-01 302
Total of all active and inactive participants 2021-01-01 11,009
Total participants 2021-01-01 11,009
2020: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 7,160
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 8,729
Number of retired or separated participants receiving benefits 2020-01-01 234
Total of all active and inactive participants 2020-01-01 8,963
Total participants 2020-01-01 8,963
2019: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 5,971
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 6,838
Number of other retired or separated participants entitled to future benefits 2019-01-01 322
Total of all active and inactive participants 2019-01-01 7,160
Total participants 2019-01-01 7,160
2018: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 5,477
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 5,971
Number of other retired or separated participants entitled to future benefits 2018-01-01 313
Total of all active and inactive participants 2018-01-01 6,284
Total participants 2018-01-01 6,284
2017: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 10,160
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 10,572
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 10,572
Total participants 2017-01-01 10,572
2016: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 8,956
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 8,988
Number of retired or separated participants receiving benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 8,988
2015: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 7,184
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 8,956
Total of all active and inactive participants 2015-01-01 8,956
2014: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6,278
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7,184
Number of retired or separated participants receiving benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 7,184
Total participants 2014-01-01 7,184

Measure	Date	Value
2022: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	11,009
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	13,308
Number of retired or separated participants receiving benefits	2022-01-01	310
Total of all active and inactive participants	2022-01-01	13,618
Total participants	2022-01-01	13,618
2021: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	8,963
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	10,707
Number of retired or separated participants receiving benefits	2021-01-01	302
Total of all active and inactive participants	2021-01-01	11,009
Total participants	2021-01-01	11,009
2020: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	7,160
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	8,729
Number of retired or separated participants receiving benefits	2020-01-01	234
Total of all active and inactive participants	2020-01-01	8,963
Total participants	2020-01-01	8,963
2019: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	5,971
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	6,838
Number of other retired or separated participants entitled to future benefits	2019-01-01	322
Total of all active and inactive participants	2019-01-01	7,160
Total participants	2019-01-01	7,160
2018: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5,477
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5,971
Number of other retired or separated participants entitled to future benefits	2018-01-01	313
Total of all active and inactive participants	2018-01-01	6,284
Total participants	2018-01-01	6,284
2017: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	10,160
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	10,572
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	10,572
Total participants	2017-01-01	10,572
2016: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	8,956
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	8,988
Number of retired or separated participants receiving benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	8,988
2015: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	7,184
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	8,956
Total of all active and inactive participants	2015-01-01	8,956
2014: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6,278
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7,184
Number of retired or separated participants receiving benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	7,184
Total participants	2014-01-01	7,184

Form 5500 Responses for SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN

2022: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Mulitple employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	192
Insurance policy start date	2022-01-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $48,475
Total amount of fees paid to insurance company	USD $539
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,079,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,475
Amount paid for insurance broker fees	539
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005557

Policy instance

Insurance contract or identification number	BCM005557
Number of Individuals Covered	10
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,801
Welfare Benefit Premiums Paid to Carrier	USD $14,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,801
Insurance broker organization code?	3

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02018

Policy instance

Insurance contract or identification number	SWBCPE02018
Number of Individuals Covered	13559
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,330
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,330
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5365100

Policy instance

Insurance contract or identification number	5365100
Number of Individuals Covered	5290
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $439,725
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,293,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $439,725
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	15
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,018
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $10,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $349
Insurance broker organization code?	3

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	863
Insurance policy start date	2022-01-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $230,308
Total amount of fees paid to insurance company	USD $2,621
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,123,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $230,308
Amount paid for insurance broker fees	2621
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	77
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,614
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $14,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,614
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218295

Policy instance

Insurance contract or identification number	0218295
Number of Individuals Covered	1508
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,346
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $213,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,346
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218296

Policy instance

Insurance contract or identification number	0218296
Number of Individuals Covered	1818
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $27,891
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $158,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,891
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218297

Policy instance

Insurance contract or identification number	0218297
Number of Individuals Covered	1226
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $35,865
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $206,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,865
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005555

Policy instance

Insurance contract or identification number	BCM005555
Number of Individuals Covered	59
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,420
Welfare Benefit Premiums Paid to Carrier	USD $51,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,420
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005556

Policy instance

Insurance contract or identification number	BCM005556
Number of Individuals Covered	43
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,381
Welfare Benefit Premiums Paid to Carrier	USD $75,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,381
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BEC005558

Policy instance

Insurance contract or identification number	BEC005558
Number of Individuals Covered	112
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	POLICY BASIC ESSENTIAL
Welfare Benefit Premiums Paid to Carrier	USD $26,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	76
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,571
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $15,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,571
Insurance broker organization code?	3

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	844
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $315,579
Total amount of fees paid to insurance company	USD $3,400
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,098,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $315,579
Amount paid for insurance broker fees	3400
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	171
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $56,573
Total amount of fees paid to insurance company	USD $600
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,272,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,573
Amount paid for insurance broker fees	600
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	18
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,161
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $399
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005556

Policy instance

Insurance contract or identification number	BCM005556
Number of Individuals Covered	47
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,093
Welfare Benefit Premiums Paid to Carrier	USD $80,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,093
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218295

Policy instance

Insurance contract or identification number	0218295
Number of Individuals Covered	1205
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $33,324
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,324
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218296

Policy instance

Insurance contract or identification number	0218296
Number of Individuals Covered	1531
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $26,538
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,538
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218297

Policy instance

Insurance contract or identification number	0218297
Number of Individuals Covered	975
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,297
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,297
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005555

Policy instance

Insurance contract or identification number	BCM005555
Number of Individuals Covered	32
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,470
Welfare Benefit Premiums Paid to Carrier	USD $35,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,470
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BEC005558

Policy instance

Insurance contract or identification number	BEC005558
Number of Individuals Covered	79
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	POLICY BASIC ESSENTIAL
Welfare Benefit Premiums Paid to Carrier	USD $18,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02018

Policy instance

Insurance contract or identification number	SWBCPE02018
Number of Individuals Covered	10707
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,770
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,770
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5365100

Policy instance

Insurance contract or identification number	5365100
Number of Individuals Covered	5001
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $357,555
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,182,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $357,555
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	19
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,454
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $494
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	202
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $52,395
Total amount of fees paid to insurance company	USD $428
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,189,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,395
Amount paid for insurance broker fees	428
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	880
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $313,066
Total amount of fees paid to insurance company	USD $2,572
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,035,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $313,066
Amount paid for insurance broker fees	2572
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	79
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,827
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $18,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,827
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218295

Policy instance

Insurance contract or identification number	0218295
Number of Individuals Covered	894
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,499
Total amount of fees paid to insurance company	USD $44
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,499
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218296

Policy instance

Insurance contract or identification number	0218296
Number of Individuals Covered	1237
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,344
Total amount of fees paid to insurance company	USD $44
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $100,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,344
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0218297

Policy instance

Insurance contract or identification number	0218297
Number of Individuals Covered	695
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,361
Total amount of fees paid to insurance company	USD $44
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,361
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005556

Policy instance

Insurance contract or identification number	BCM005556
Number of Individuals Covered	60
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,981
Welfare Benefit Premiums Paid to Carrier	USD $95,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,981
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BEC005558

Policy instance

Insurance contract or identification number	BEC005558
Number of Individuals Covered	90
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	POLICY BASIC ESSENTIAL
Welfare Benefit Premiums Paid to Carrier	USD $21,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5365100

Policy instance

Insurance contract or identification number	5365100
Number of Individuals Covered	5137
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $359,010
Total amount of fees paid to insurance company	USD $44
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,175,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $359,010
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02018

Policy instance

Insurance contract or identification number	SWBCPE02018
Number of Individuals Covered	8729
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,629
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,629
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005555

Policy instance

Insurance contract or identification number	BCM005555
Number of Individuals Covered	30
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,052
Welfare Benefit Premiums Paid to Carrier	USD $40,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,052
Insurance broker organization code?	3

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02018

Policy instance

Insurance contract or identification number	SWBCPE02018
Number of Individuals Covered	6551
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,762
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,762
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TS05365100

Policy instance

Insurance contract or identification number	TS05365100
Number of Individuals Covered	4421
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $262,450
Total amount of fees paid to insurance company	USD $3,765
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,032,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $262,450
Amount paid for insurance broker fees	3765
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	23
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,651
Total amount of fees paid to insurance company	USD $53
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $21,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $999
Insurance broker organization code?	3
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	FEES

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	77
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,521
Total amount of fees paid to insurance company	USD $36
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $387,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,521
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	890
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $257,167
Total amount of fees paid to insurance company	USD $890
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,769,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $257,167
Amount paid for insurance broker fees	890
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	79
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,769
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $17,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,769
Insurance broker organization code?	3

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02018

Policy instance

Insurance contract or identification number	SWBCPE02018
Number of Individuals Covered	5949
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,257
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,257
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TS05365100

Policy instance

Insurance contract or identification number	TS05365100
Number of Individuals Covered	3514
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $202,755
Total amount of fees paid to insurance company	USD $568
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,767,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $202,755
Amount paid for insurance broker fees	568
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	42
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,456
Total amount of fees paid to insurance company	USD $569
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $37,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,285
Insurance broker organization code?	3
Amount paid for insurance broker fees	120
Additional information about fees paid to insurance broker	FEES

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	28
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,787
Total amount of fees paid to insurance company	USD $58
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,787
Amount paid for insurance broker fees	58
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	607
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $167,519
Total amount of fees paid to insurance company	USD $2,085
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,742,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $167,519
Amount paid for insurance broker fees	2085
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	81
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,741
Total amount of fees paid to insurance company	USD $82
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $16,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,741
Amount paid for insurance broker fees	82
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TS05365100

Policy instance

Insurance contract or identification number	TS05365100
Number of Individuals Covered	2892
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $119,180
Total amount of fees paid to insurance company	USD $11,626
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,146,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $119,180
Amount paid for insurance broker fees	11626
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY, INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	50
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,884
Total amount of fees paid to insurance company	USD $1,968
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $53,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,735
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES
Insurance broker name	WILSON BENEFITS INC.

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	10
Insurance policy start date	2017-10-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69
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
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY, INC.

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

786437

Policy instance

Insurance contract or identification number	786437
Number of Individuals Covered	199
Insurance policy start date	2017-10-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,073
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $261,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,073
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY INC.

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPE02015

Policy instance

Insurance contract or identification number	SWBCPE02015
Number of Individuals Covered	5397
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,200
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,200
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

9260169

Policy instance

Insurance contract or identification number	9260169
Number of Individuals Covered	60
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,051
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $11,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,051
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY, INC.

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

10780-1002

Policy instance

Insurance contract or identification number	10780-1002
Number of Individuals Covered	695
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,957
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,957
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

CATHOLIC LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 57347 )

Policy contract number

SWBCPEO02015

Policy instance

Insurance contract or identification number	SWBCPEO02015
Number of Individuals Covered	6174
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,094
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,094
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

626294

Policy instance

Insurance contract or identification number	626294
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $388
Total amount of fees paid to insurance company	USD $1,000
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $-3,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-612
Amount paid for insurance broker fees	1000
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

626294

Policy instance

Insurance contract or identification number	626294
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $-187
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE AND VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $-205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-194
Amount paid for insurance broker fees	7
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

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

Policy contract number

0903218

Policy instance

Insurance contract or identification number	0903218
Number of Individuals Covered	1646
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $115,138
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $767,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $115,138
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

10780-1001

Policy instance

Insurance contract or identification number	10780-1001
Number of Individuals Covered	555
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $7,973
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,973
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

10780-1004

Policy instance

Insurance contract or identification number	10780-1004
Number of Individuals Covered	349
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,551
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,551
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

10780-1003

Policy instance

Insurance contract or identification number	10780-1003
Number of Individuals Covered	448
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,304
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,304
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

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

Policy contract number

304036

Policy instance

Insurance contract or identification number	304036
Number of Individuals Covered	1087
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,747
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPENDENT LIFE, SUP LIVE & BASIC AD
Welfare Benefit Premiums Paid to Carrier	USD $221,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,747
Insurance broker organization code?	3
Insurance broker name	SWBC LIFE INSURANCE AGENCY

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E4360962

Policy instance

Insurance contract or identification number	E4360962
Number of Individuals Covered	81
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,432
Total amount of fees paid to insurance company	USD $11,242
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	OFF JOB ACC INS & CRITCAL ILLNESS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,868
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES
Insurance broker name	TIMOTHY COBB

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

626294

Policy instance

Insurance contract or identification number	626294
Number of Individuals Covered	1348
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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 number

10780-1003

Policy instance

Insurance contract or identification number	10780-1003
Number of Individuals Covered	424
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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 number

10780-1004

Policy instance

Insurance contract or identification number	10780-1004
Number of Individuals Covered	188
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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 number

10780-1001

Policy instance

Insurance contract or identification number	10780-1001
Number of Individuals Covered	501
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
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 number

10780-1002

Policy instance

Insurance contract or identification number	10780-1002
Number of Individuals Covered	556
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

626294

Policy instance

Insurance contract or identification number	626294
Number of Individuals Covered	568
Insurance policy start date	2013-10-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SWBC PROFESSIONAL EMPLOYER SERVICES V, LLC CAFETERIA PLAN
Employer identification number (EIN):	273708085
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2010-10-15
Company Identification Number:	0801331529
Legal Registered Office Address:	9311 SAN PEDRO AVE STE 600 SAN ANTONIO United States of America (USA) 78216