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SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 401k Plan overview

Plan NameSPRAYING SYSTEMS CO GROUP MEDICAL PLAN
Plan identification number 503

SPRAYING SYSTEMS CO GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

SPRAYING SYSTEMS CO has sponsored the creation of one or more 401k plans.

Company Name:SPRAYING SYSTEMS CO
Employer identification number (EIN):361922920
NAIC Classification:332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPRAYING SYSTEMS CO GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01
5032021-01-01
5032020-01-01DANA DIXON2021-07-19 DANA DIXON2021-07-19
5032019-01-01
5032018-01-01JIM YEHLING
5032018-01-01JIM YEHLING2019-06-10
5032017-01-01JIM YEHLING
5032017-01-01
5032016-01-01JAMES YEHLING
5032015-01-01JAMES YEHLING
5032015-01-01JAMES YEHLING
5032014-01-01JAMES YEHLING
5032013-01-01JAMES YEHLING
5032012-01-01JAMES YEHLING
5032011-01-01JAMES YEHLING
5032010-01-01JAMES YEHLING
5032009-01-01
5032009-01-01JAMES YEHLING

Plan Statistics for SPRAYING SYSTEMS CO GROUP MEDICAL PLAN

401k plan membership statisitcs for SPRAYING SYSTEMS CO GROUP MEDICAL PLAN

Measure Date Value
2022: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01908
Total number of active participants reported on line 7a of the Form 55002022-01-01944
Total of all active and inactive participants2022-01-01944
2021: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01926
Total number of active participants reported on line 7a of the Form 55002021-01-01900
Total of all active and inactive participants2021-01-01900
2020: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01953
Total number of active participants reported on line 7a of the Form 55002020-01-011,028
Total of all active and inactive participants2020-01-011,028
2019: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01922
Total number of active participants reported on line 7a of the Form 55002019-01-01952
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01952
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
2018: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01883
Total number of active participants reported on line 7a of the Form 55002018-01-01901
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01901
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
2017: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01858
Total number of active participants reported on line 7a of the Form 55002017-01-01869
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01869
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
2016: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01866
Total number of active participants reported on line 7a of the Form 55002016-01-01865
Total of all active and inactive participants2016-01-01865
2015: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01861
Total number of active participants reported on line 7a of the Form 55002015-01-01865
Number of retired or separated participants receiving benefits2015-01-012
Total of all active and inactive participants2015-01-01867
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
2014: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01857
Total number of active participants reported on line 7a of the Form 55002014-01-01856
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-01857
2013: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01838
Total number of active participants reported on line 7a of the Form 55002013-01-01846
Number of retired or separated participants receiving benefits2013-01-014
Total of all active and inactive participants2013-01-01850
2012: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01837
Total number of active participants reported on line 7a of the Form 55002012-01-01836
Total of all active and inactive participants2012-01-01836
2011: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01837
Total number of active participants reported on line 7a of the Form 55002011-01-01834
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01834
2010: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01862
Total number of active participants reported on line 7a of the Form 55002010-01-01829
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01829
2009: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01919
Total number of active participants reported on line 7a of the Form 55002009-01-01912
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01912

Financial Data on SPRAYING SYSTEMS CO GROUP MEDICAL PLAN

Measure Date Value
2015 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2015 401k financial data
Total income from all sources2015-12-31$0
Expenses. Total of all expenses incurred2015-12-31$0
Value of fidelity bond covering the plan2015-12-31$0
Net income (gross income less expenses)2015-12-31$0
Net plan assets at end of year (total assets less liabilities)2015-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$0
2014 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$0
Expenses. Total of all expenses incurred2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$0
Net income (gross income less expenses)2014-12-31$0
Net plan assets at end of year (total assets less liabilities)2014-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
2013 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$0
Expenses. Total of all expenses incurred2013-12-31$0
Value of fidelity bond covering the plan2013-12-31$0
Net income (gross income less expenses)2013-12-31$0
Net plan assets at end of year (total assets less liabilities)2013-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0
2012 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2012 401k financial data
Total income from all sources2012-12-31$0
Expenses. Total of all expenses incurred2012-12-31$0
Value of fidelity bond covering the plan2012-12-31$0
Net income (gross income less expenses)2012-12-31$0
Net plan assets at end of year (total assets less liabilities)2012-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
2011 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2011 401k financial data
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$0
Expenses. Total of all expenses incurred2011-12-31$0
Total plan assets at beginning of year2011-12-31$0
Value of fidelity bond covering the plan2011-12-31$0
Net income (gross income less expenses)2011-12-31$0
Net plan assets at end of year (total assets less liabilities)2011-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
2010 : SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2010 401k financial data
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$0
Expenses. Total of all expenses incurred2010-12-31$0
Total plan assets at beginning of year2010-12-31$0
Value of fidelity bond covering the plan2010-12-31$0
Net income (gross income less expenses)2010-12-31$0
Net plan assets at end of year (total assets less liabilities)2010-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$0

Form 5500 Responses for SPRAYING SYSTEMS CO GROUP MEDICAL PLAN

2022: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: SPRAYING SYSTEMS CO GROUP MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered16
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,442
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $270,786
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered44
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $369,921
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered71
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $517,906
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered121
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $778,360
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered149
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $848,114
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberB84396
Policy instance 1
Insurance contract or identification numberB84396
Number of Individuals Covered213
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $967,642

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