PETERSEN ALUMINUM CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PETERSEN ALUMINUM CORPORATION INSURANCE PLAN
Measure | Date | Value |
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2019: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 216 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 0 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 0 |
2018: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-07-01 | 211 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 215 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
Total of all active and inactive participants | 2018-07-01 | 216 |
2017: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 313 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 323 |
Number of retired or separated participants receiving benefits | 2017-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
Total of all active and inactive participants | 2017-07-01 | 323 |
2016: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-07-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 313 |
Number of retired or separated participants receiving benefits | 2016-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 0 |
Total of all active and inactive participants | 2016-07-01 | 313 |
2015: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-07-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 302 |
Number of retired or separated participants receiving benefits | 2015-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
Total of all active and inactive participants | 2015-07-01 | 303 |
2014: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 343 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 303 |
Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 0 |
Total of all active and inactive participants | 2014-07-01 | 303 |
2013: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-07-01 | 378 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 343 |
Number of retired or separated participants receiving benefits | 2013-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 0 |
Total of all active and inactive participants | 2013-07-01 | 343 |
2012: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 381 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 378 |
Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
Total of all active and inactive participants | 2012-07-01 | 378 |
2011: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 384 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 381 |
Number of retired or separated participants receiving benefits | 2011-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
Total of all active and inactive participants | 2011-07-01 | 381 |
2009: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-07-01 | 391 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 388 |
Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
Total of all active and inactive participants | 2009-07-01 | 388 |
2008: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-07-01 | 418 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-07-01 | 391 |
Number of retired or separated participants receiving benefits | 2008-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2008-07-01 | 0 |
Total of all active and inactive participants | 2008-07-01 | 391 |
2007: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2007 401k membership |
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Total participants, beginning-of-year | 2007-07-01 | 428 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-07-01 | 418 |
Number of retired or separated participants receiving benefits | 2007-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2007-07-01 | 0 |
Total of all active and inactive participants | 2007-07-01 | 418 |
2006: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2006 401k membership |
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Total participants, beginning-of-year | 2006-07-01 | 660 |
Total number of active participants reported on line 7a of the Form 5500 | 2006-07-01 | 428 |
Number of retired or separated participants receiving benefits | 2006-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2006-07-01 | 0 |
Total of all active and inactive participants | 2006-07-01 | 428 |
2005: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2005 401k membership |
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Total participants, beginning-of-year | 2005-07-01 | 394 |
Total number of active participants reported on line 7a of the Form 5500 | 2005-07-01 | 660 |
Number of retired or separated participants receiving benefits | 2005-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2005-07-01 | 0 |
Total of all active and inactive participants | 2005-07-01 | 660 |
2004: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2004 401k membership |
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Total participants, beginning-of-year | 2004-07-01 | 397 |
Total number of active participants reported on line 7a of the Form 5500 | 2004-07-01 | 394 |
Number of retired or separated participants receiving benefits | 2004-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2004-07-01 | 0 |
Total of all active and inactive participants | 2004-07-01 | 394 |
2003: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2003 401k membership |
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Total participants, beginning-of-year | 2003-07-01 | 378 |
Total number of active participants reported on line 7a of the Form 5500 | 2003-07-01 | 397 |
Number of retired or separated participants receiving benefits | 2003-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2003-07-01 | 0 |
Total of all active and inactive participants | 2003-07-01 | 397 |
2002: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2002 401k membership |
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Total participants, beginning-of-year | 2002-07-01 | 360 |
Total number of active participants reported on line 7a of the Form 5500 | 2002-07-01 | 378 |
Number of retired or separated participants receiving benefits | 2002-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2002-07-01 | 0 |
Total of all active and inactive participants | 2002-07-01 | 378 |
2001: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2001 401k membership |
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Total participants, beginning-of-year | 2001-07-01 | 342 |
Total number of active participants reported on line 7a of the Form 5500 | 2001-07-01 | 360 |
Number of retired or separated participants receiving benefits | 2001-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2001-07-01 | 0 |
Total of all active and inactive participants | 2001-07-01 | 360 |
2000: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 2000 401k membership |
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Total participants, beginning-of-year | 2000-07-01 | 324 |
Total number of active participants reported on line 7a of the Form 5500 | 2000-07-01 | 342 |
Number of retired or separated participants receiving benefits | 2000-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2000-07-01 | 0 |
Total of all active and inactive participants | 2000-07-01 | 342 |
1999: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 1999 401k membership |
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Total participants, beginning-of-year | 1999-07-01 | 306 |
Total number of active participants reported on line 7a of the Form 5500 | 1999-07-01 | 324 |
Number of retired or separated participants receiving benefits | 1999-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 1999-07-01 | 0 |
Total of all active and inactive participants | 1999-07-01 | 324 |
1998: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 1998 401k membership |
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Total participants, beginning-of-year | 1998-07-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 1998-07-01 | 306 |
Number of retired or separated participants receiving benefits | 1998-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 1998-07-01 | 0 |
Total of all active and inactive participants | 1998-07-01 | 306 |
1997: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 1997 401k membership |
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Total participants, beginning-of-year | 1997-07-01 | 300 |
Total number of active participants reported on line 7a of the Form 5500 | 1997-07-01 | 303 |
Number of retired or separated participants receiving benefits | 1997-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 1997-07-01 | 0 |
Total of all active and inactive participants | 1997-07-01 | 303 |
1996: PETERSEN ALUMINUM CORPORATION INSURANCE PLAN 1996 401k membership |
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Total participants, beginning-of-year | 1996-07-01 | 122 |
Total number of active participants reported on line 7a of the Form 5500 | 1996-07-01 | 300 |
Number of retired or separated participants receiving benefits | 1996-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 1996-07-01 | 0 |
Total of all active and inactive participants | 1996-07-01 | 300 |
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 3 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 220 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $4,839 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 | Commission paid to Insurance Broker | USD $4,510 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 2 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 220 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $2,812 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Commission paid to Insurance Broker | USD $2,595 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 4 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 220 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $2,717 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 | Commission paid to Insurance Broker | USD $2,517 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 329 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $92,742 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | Dental Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,496,308 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $70,022 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 2 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 181 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $2,123 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Commission paid to Insurance Broker | USD $2,123 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 3 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 181 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $3,469 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 | Commission paid to Insurance Broker | USD $3,469 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 4 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 181 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $2,198 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 | Commission paid to Insurance Broker | USD $2,198 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 337 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-08-31 | Total amount of commissions paid to insurance broker | USD $94,560 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | Dental Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,555,352 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $94,560 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 4 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 168 | Insurance policy start date | 2016-09-01 | Insurance policy end date | 2017-08-31 | Total amount of commissions paid to insurance broker | USD $2,386 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 2 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 168 | Insurance policy start date | 2016-09-01 | Insurance policy end date | 2017-08-31 | Total amount of commissions paid to insurance broker | USD $2,301 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160364 |
Policy instance | 3 |
Insurance contract or identification number | 160364 | Number of Individuals Covered | 168 | Insurance policy start date | 2016-09-01 | Insurance policy end date | 2017-08-31 | Total amount of commissions paid to insurance broker | USD $3,697 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 323 | Insurance policy start date | 2016-09-01 | Insurance policy end date | 2017-08-31 | Total amount of commissions paid to insurance broker | USD $83,252 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,191,900 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 303 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $67,762 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,863,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $67,762 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 873644G |
Policy instance | 2 |
Insurance contract or identification number | 873644G | Number of Individuals Covered | 172 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $2,383 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $19,861 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,383 | Insurance broker organization code? | 3 | Insurance broker name | HUB INTL MIDWEST LIMITED |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 873644G |
Policy instance | 2 |
Insurance contract or identification number | 873644G | Number of Individuals Covered | 172 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $14,300 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $119,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,342 | Insurance broker organization code? | 3 | Insurance broker name | HUB INTL MIDWEST LIMITED |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 303 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,891,176 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 343 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $64,173 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,716,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,173 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 873644G |
Policy instance | 2 |
Insurance contract or identification number | 873644G | Number of Individuals Covered | 172 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $15,277 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $127,306 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,277 | Insurance broker organization code? | 3 | Insurance broker name | HUB INTL MIDWEST LIMITED |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 3 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 197 | Insurance policy start date | 2012-08-15 | Insurance policy end date | 2013-06-14 | Total amount of commissions paid to insurance broker | USD $10,469 | Total amount of fees paid to insurance company | USD $188 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $104,713 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,469 | Amount paid for insurance broker fees | 188 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 378 | Insurance policy start date | 2011-09-01 | Insurance policy end date | 2012-08-31 | Total amount of commissions paid to insurance broker | USD $63,652 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,692,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63,652 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 197 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $13,333 | Total amount of fees paid to insurance company | USD $251 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $133,616 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,333 | Amount paid for insurance broker fees | 251 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 381 | Insurance policy start date | 2010-09-01 | Insurance policy end date | 2011-08-31 | Total amount of commissions paid to insurance broker | USD $63,600 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,696,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 197 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $12,414 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $123,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 1 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 207 | Insurance policy start date | 2009-10-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $855 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 2 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 202 | Insurance policy start date | 2009-09-01 | Insurance policy end date | 2010-08-31 | Total amount of commissions paid to insurance broker | USD $2,115 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $42,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 101292 |
Policy instance | 5 |
Insurance contract or identification number | LTD 101292 | Number of Individuals Covered | 202 | Insurance policy start date | 2010-09-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $375 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,107 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 7 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 384 | Insurance policy start date | 2009-09-01 | Insurance policy end date | 2010-08-31 | Total amount of commissions paid to insurance broker | USD $65,477 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,593,228 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 101292 |
Policy instance | 6 |
Insurance contract or identification number | LTD 101292 | Number of Individuals Covered | 202 | Insurance policy start date | 2009-09-01 | Insurance policy end date | 2010-08-31 | Total amount of commissions paid to insurance broker | USD $4,499 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,278 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 202 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2010-09-30 | Total amount of commissions paid to insurance broker | USD $1,258 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 202 | Insurance policy start date | 2010-09-01 | Insurance policy end date | 2010-09-30 | 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 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $3,526 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 5 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 203 | Insurance policy start date | 2008-08-01 | Insurance policy end date | 2009-07-31 | Total amount of commissions paid to insurance broker | USD $837 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $9,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $837 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 202 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $3,773 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,328 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,773 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 202 | Insurance policy start date | 2008-09-01 | Insurance policy end date | 2009-08-31 | Total amount of commissions paid to insurance broker | USD $2,115 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $42,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,115 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD101292 |
Policy instance | 2 |
Insurance contract or identification number | LTD101292 | Number of Individuals Covered | 202 | Insurance policy start date | 2008-09-01 | Insurance policy end date | 2009-08-31 | Total amount of commissions paid to insurance broker | USD $4,499 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,978 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,499 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 388 | Insurance policy start date | 2008-09-01 | Insurance policy end date | 2009-08-31 | Total amount of commissions paid to insurance broker | USD $67,355 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,489,968 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $67,355 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 5 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 199 | Insurance policy start date | 2007-08-01 | Insurance policy end date | 2008-07-31 | Total amount of commissions paid to insurance broker | USD $819 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,983 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $819 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 202 | Insurance policy start date | 2008-06-01 | Insurance policy end date | 2009-05-31 | Total amount of commissions paid to insurance broker | USD $3,764 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $56,367 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,764 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 202 | Insurance policy start date | 2007-09-01 | Insurance policy end date | 2008-08-31 | Total amount of commissions paid to insurance broker | USD $2,094 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $41,870 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,094 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD101292 |
Policy instance | 2 |
Insurance contract or identification number | LTD101292 | Number of Individuals Covered | 202 | Insurance policy start date | 2007-09-01 | Insurance policy end date | 2008-08-31 | Total amount of commissions paid to insurance broker | USD $4,426 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,426 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 391 | Insurance policy start date | 2007-09-01 | Insurance policy end date | 2008-08-31 | Total amount of commissions paid to insurance broker | USD $72,560 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,444,716 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $72,560 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD101292 |
Policy instance | 2 |
Insurance contract or identification number | LTD101292 | Number of Individuals Covered | 200 | Insurance policy start date | 2006-09-01 | Insurance policy end date | 2007-08-31 | Total amount of commissions paid to insurance broker | USD $3,223 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,470 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,223 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 200 | Insurance policy start date | 2006-09-01 | Insurance policy end date | 2007-08-31 | Total amount of commissions paid to insurance broker | USD $1,643 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $32,854 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,643 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 202 | Insurance policy start date | 2007-06-01 | Insurance policy end date | 2008-05-31 | Total amount of commissions paid to insurance broker | USD $3,746 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,746 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 418 | Insurance policy start date | 2006-09-01 | Insurance policy end date | 2007-08-31 | Total amount of commissions paid to insurance broker | USD $69,233 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,386,708 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $69,233 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 5 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2006-08-01 | Insurance policy end date | 2007-07-31 | Total amount of commissions paid to insurance broker | USD $800 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $800 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 5 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2005-08-01 | Insurance policy end date | 2006-07-31 | Total amount of commissions paid to insurance broker | USD $800 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $800 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 200 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-06-01 | Total amount of commissions paid to insurance broker | USD $3,706 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $51,943 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,706 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 198 | Insurance policy start date | 2005-09-01 | Insurance policy end date | 2006-09-01 | Total amount of commissions paid to insurance broker | USD $1,192 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $23,839 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,192 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD101292 |
Policy instance | 2 |
Insurance contract or identification number | LTD101292 | Number of Individuals Covered | 198 | Insurance policy start date | 2005-09-01 | Insurance policy end date | 2006-09-01 | Total amount of commissions paid to insurance broker | USD $2,021 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,416 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,021 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 428 | Insurance policy start date | 2005-09-01 | Insurance policy end date | 2006-08-31 | Total amount of commissions paid to insurance broker | USD $64,056 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,279,751 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,056 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD101292 |
Policy instance | 2 |
Insurance contract or identification number | LTD101292 | Number of Individuals Covered | 193 | Insurance policy start date | 2004-09-01 | Insurance policy end date | 2005-09-01 | Total amount of commissions paid to insurance broker | USD $1,572 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,435 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,572 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 660 | Insurance policy start date | 2004-09-01 | Insurance policy end date | 2005-08-31 | Total amount of commissions paid to insurance broker | USD $43,498 | Total amount of fees paid to insurance company | USD $957 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $1,223,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $43,498 | Amount paid for insurance broker fees | 957 | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | Insurance broker organization code? | 3 | Insurance broker name | THE AMERICAN INSURANCE AGENCY |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 125554 |
Policy instance | 3 |
Insurance contract or identification number | GL 125554 | Number of Individuals Covered | 193 | Insurance policy start date | 2004-09-01 | Insurance policy end date | 2005-09-01 | Total amount of commissions paid to insurance broker | USD $1,001 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $20,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,001 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 157090 |
Policy instance | 4 |
Insurance contract or identification number | G 157090 | Number of Individuals Covered | 198 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-06-01 | Total amount of commissions paid to insurance broker | USD $3,667 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,332 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,667 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 5 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2004-08-01 | Insurance policy end date | 2005-07-31 | Total amount of commissions paid to insurance broker | USD $800 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $800 | Insurance broker organization code? | 3 | Insurance broker name | RAYMOND H ZANARINI |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2003-08-01 | Insurance policy end date | 2004-07-31 | Total amount of commissions paid to insurance broker | USD $773 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,461 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $773 | Insurance broker organization code? | 3 | Insurance broker name | THE AMERICAN INSURANCE AGENCY |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 394 | Insurance policy start date | 2003-09-01 | Insurance policy end date | 2004-08-31 | Total amount of commissions paid to insurance broker | USD $49,969 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,133,625 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $49,969 | Insurance broker organization code? | 3 | Insurance broker name | THE AMERICAN INSURANCE AGENCY |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2002-08-01 | Insurance policy end date | 2003-07-31 | Total amount of commissions paid to insurance broker | USD $746 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $8,167 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $746 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 397 | Insurance policy start date | 2002-09-01 | Insurance policy end date | 2003-08-31 | Total amount of commissions paid to insurance broker | USD $39,850 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,077,577 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $39,850 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2001-08-15 | Insurance policy end date | 2002-07-31 | Total amount of commissions paid to insurance broker | USD $719 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $719 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 378 | Insurance policy start date | 2001-09-01 | Insurance policy end date | 2002-08-31 | Total amount of commissions paid to insurance broker | USD $38,653 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $889,319 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $38,653 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 360 | Insurance policy start date | 2000-09-01 | Insurance policy end date | 2001-08-31 | Total amount of commissions paid to insurance broker | USD $27,634 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $667,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,634 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 2000-08-15 | Insurance policy end date | 2001-08-15 | Total amount of commissions paid to insurance broker | USD $706 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,578 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $706 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 1999-08-15 | Insurance policy end date | 2000-08-15 | Total amount of commissions paid to insurance broker | USD $679 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $7,284 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $679 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 342 | Insurance policy start date | 1999-08-15 | Insurance policy end date | 2000-08-31 | Total amount of commissions paid to insurance broker | USD $30,885 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $619,884 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,885 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F186922 |
Policy instance | 2 |
Insurance contract or identification number | F186922 | Number of Individuals Covered | 192 | Insurance policy start date | 1998-08-15 | Insurance policy end date | 1999-08-15 | Total amount of commissions paid to insurance broker | USD $651 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $6,990 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $651 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P86922 |
Policy instance | 1 |
Insurance contract or identification number | P86922 | Number of Individuals Covered | 324 | Insurance policy start date | 1998-08-15 | Insurance policy end date | 1999-08-14 | Total amount of commissions paid to insurance broker | USD $24,697 | 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 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $505,874 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,697 | Insurance broker organization code? | 3 | Insurance broker name | MACK AND PARKER |
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