SPINE INSTITUTE OF LOUISIANA, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST
401k plan membership statisitcs for SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST
| Measure | Date | Value |
|---|
| 2022: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 37 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 55 |
| Total of all active and inactive participants | 2022-01-01 | 55 |
| 2021: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 37 |
| Total of all active and inactive participants | 2021-01-01 | 37 |
| 2020: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 34 |
| Total of all active and inactive participants | 2020-01-01 | 34 |
| 2019: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 36 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 34 |
| Total of all active and inactive participants | 2019-01-01 | 34 |
| 2018: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 36 |
| Total of all active and inactive participants | 2018-01-01 | 36 |
| 2017: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 20 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 38 |
| Total of all active and inactive participants | 2017-01-01 | 38 |
| 2016: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 20 |
| Total of all active and inactive participants | 2016-01-01 | 20 |
| 2015: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 39 |
| Total of all active and inactive participants | 2015-01-01 | 39 |
| 2014: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 34 |
| Total of all active and inactive participants | 2014-01-01 | 34 |
| 2013: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 30 |
| Total of all active and inactive participants | 2013-01-01 | 30 |
| 2012: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 27 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 30 |
| Total of all active and inactive participants | 2012-01-01 | 30 |
| Measure | Date | Value |
|---|
| 2022 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $828,853 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $832,848 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $828,185 |
| Total plan assets at end of year | 2022-12-31 | $9,559 |
| Total plan assets at beginning of year | 2022-12-31 | $13,554 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $4,663 |
| Net income (gross income less expenses) | 2022-12-31 | $-3,995 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $9,559 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $13,554 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $828,853 |
| 2021 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $689,953 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $685,383 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $681,146 |
| Total plan assets at end of year | 2021-12-31 | $13,554 |
| Total plan assets at beginning of year | 2021-12-31 | $8,984 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $4,237 |
| Net income (gross income less expenses) | 2021-12-31 | $4,570 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $13,554 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $8,984 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $689,953 |
| 2020 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $550,573 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $551,290 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $548,903 |
| Total plan assets at end of year | 2020-12-31 | $8,984 |
| Total plan assets at beginning of year | 2020-12-31 | $9,701 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $2,387 |
| Net income (gross income less expenses) | 2020-12-31 | $-717 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $8,984 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $9,701 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $550,573 |
| 2019 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $512,188 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $508,405 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $503,070 |
| Total plan assets at end of year | 2019-12-31 | $9,701 |
| Total plan assets at beginning of year | 2019-12-31 | $5,918 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $5,335 |
| Net income (gross income less expenses) | 2019-12-31 | $3,783 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $9,701 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $5,918 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $512,188 |
| 2018 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $446,925 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $448,172 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $443,329 |
| Total plan assets at end of year | 2018-12-31 | $5,918 |
| Total plan assets at beginning of year | 2018-12-31 | $7,165 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $4,843 |
| Net income (gross income less expenses) | 2018-12-31 | $-1,247 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $5,918 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $7,165 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $446,925 |
| 2017 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $508,293 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $507,258 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $498,121 |
| Total plan assets at end of year | 2017-12-31 | $7,165 |
| Total plan assets at beginning of year | 2017-12-31 | $6,130 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $9,137 |
| Net income (gross income less expenses) | 2017-12-31 | $1,035 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $7,165 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $6,130 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $508,293 |
| 2016 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $446,422 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $446,616 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $440,712 |
| Total plan assets at end of year | 2016-12-31 | $6,130 |
| Total plan assets at beginning of year | 2016-12-31 | $6,324 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $5,904 |
| Net income (gross income less expenses) | 2016-12-31 | $-194 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $6,130 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $6,324 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $446,422 |
| 2015 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $408,449 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $432,365 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $426,419 |
| Total plan assets at end of year | 2015-12-31 | $6,324 |
| Total plan assets at beginning of year | 2015-12-31 | $30,240 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $5,946 |
| Net income (gross income less expenses) | 2015-12-31 | $-23,916 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $6,324 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $30,240 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $408,449 |
| 2014 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $444,206 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $437,630 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $413,905 |
| Total plan assets at end of year | 2014-12-31 | $30,240 |
| Total plan assets at beginning of year | 2014-12-31 | $23,664 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $23,725 |
| Net income (gross income less expenses) | 2014-12-31 | $6,576 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $30,240 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $23,664 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $444,206 |
| 2013 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $448,027 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $441,782 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $420,900 |
| Total plan assets at end of year | 2013-12-31 | $23,664 |
| Total plan assets at beginning of year | 2013-12-31 | $17,419 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $20,882 |
| Net income (gross income less expenses) | 2013-12-31 | $6,245 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $23,664 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $17,419 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $448,027 |
| 2012 : SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $425,304 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $407,885 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $387,634 |
| Total plan assets at end of year | 2012-12-31 | $17,419 |
| Total plan assets at beginning of year | 2012-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $20,251 |
| Net income (gross income less expenses) | 2012-12-31 | $17,419 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $17,419 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $425,304 |
| 2022: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 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 funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SPINE INSTITUTE OF LOUISIANA, LLC SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 2012-01-01 | Submission has been amended | Yes |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,174 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $35,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,174 | | Insurance broker organization code? | 5 |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 55 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $17,414 | | Total amount of fees paid to insurance company | USD $2,451 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $790,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,414 | | Amount paid for insurance broker fees | 2451 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 37 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,609 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $40,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,609 | | Insurance broker organization code? | 5 |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 37 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $14,652 | | Total amount of fees paid to insurance company | USD $2,311 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $638,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,652 | | Amount paid for insurance broker fees | 2311 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,241 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $36,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,241 | | Insurance broker organization code? | 5 |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $13,306 | | Total amount of fees paid to insurance company | USD $2,387 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $511,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,306 | | Amount paid for insurance broker fees | 2387 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,283 | | Total amount of fees paid to insurance company | USD $2,424 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $459,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,283 | | Amount paid for insurance broker fees | 2424 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,816 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $39,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,816 | | Insurance broker organization code? | 5 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 36 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,629 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $26,576 | | 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? | 5 |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 36 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $13,179 | | Total amount of fees paid to insurance company | USD $2,174 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $415,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,179 | | Amount paid for insurance broker fees | 2174 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | INDIVIDUAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,323 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $25,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,323 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,242 | | Total amount of fees paid to insurance company | USD $4,387 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $465,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,242 | | Amount paid for insurance broker fees | 4387 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | INDIVIDUAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $318 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,911 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $24,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,911 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $10,959 | | Total amount of fees paid to insurance company | USD $4,145 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $383,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,959 | | Amount paid for insurance broker fees | 4145 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | INDIVIDUAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $59 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | INDIVIDUAL POLICIES | | Welfare Benefit Premiums Paid to Carrier | USD $1,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,136 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $25,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,136 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $11,319 | | Total amount of fees paid to insurance company | USD $21,414 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $355,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,319 | | Amount paid for insurance broker fees | 21414 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $9,808 | | Total amount of fees paid to insurance company | USD $18,563 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $347,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,808 | | Amount paid for insurance broker fees | 18563 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,489 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $22,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,489 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $140 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | SUPPLEMENTAL LIFE, INDIVIDUAL POLIC | | Welfare Benefit Premiums Paid to Carrier | USD $1,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $140 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | INDIVIDUAL POLICES | | Welfare Benefit Premiums Paid to Carrier | USD $612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 4 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | INDIVIDUAL POLICES | | Welfare Benefit Premiums Paid to Carrier | USD $612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 3 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $176 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | SUPPLEMENTAL LIFE, INDIVIDUAL POLIC | | Welfare Benefit Premiums Paid to Carrier | USD $1,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $176 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 2 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,808 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $22,061 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,808 | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) |
| Policy contract number | NOT AVAILABLE |
| Policy instance | 1 |
| Insurance contract or identification number | NOT AVAILABLE | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,861 | | Total amount of fees paid to insurance company | USD $17,810 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | COMPLIANCE | | Welfare Benefit Premiums Paid to Carrier | USD $334,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,861 | | Amount paid for insurance broker fees | 17810 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES | | Insurance broker organization code? | 5 | | Insurance broker name | IMA, INC. |
|
