AON CORPORATION has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2023 : AHCS RETIREE BENEFITS PLAN 2023 401k financial data |
|---|
| Total income from all sources | 2023-12-31 | $1,172,024 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $455,336 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $383,031 |
| Total plan assets at end of year | 2023-12-31 | $6,546,270 |
| Total plan assets at beginning of year | 2023-12-31 | $5,829,582 |
| Value of fidelity bond covering the plan | 2023-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $72,305 |
| Other income received | 2023-12-31 | $1,172,024 |
| Net income (gross income less expenses) | 2023-12-31 | $716,688 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $6,546,270 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $5,829,582 |
| 2022 : AHCS RETIREE BENEFITS PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $-787,510 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $502,213 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $411,360 |
| Total plan assets at end of year | 2022-12-31 | $5,829,582 |
| Total plan assets at beginning of year | 2022-12-31 | $7,119,305 |
| Value of fidelity bond covering the plan | 2022-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $85,853 |
| Other income received | 2022-12-31 | $-787,510 |
| Net income (gross income less expenses) | 2022-12-31 | $-1,289,723 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $5,829,582 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $7,119,305 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $5,000 |
| 2021 : AHCS RETIREE BENEFITS PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $966,155 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $307,863 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $489,676 |
| Total plan assets at end of year | 2021-12-31 | $7,119,305 |
| Total plan assets at beginning of year | 2021-12-31 | $6,461,013 |
| Value of fidelity bond covering the plan | 2021-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $-224,510 |
| Other income received | 2021-12-31 | $966,155 |
| Net income (gross income less expenses) | 2021-12-31 | $658,292 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $7,119,305 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $6,461,013 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $42,697 |
| 2020 : AHCS RETIREE BENEFITS PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $990,962 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $249,045 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $1,016,703 |
| Total plan assets at end of year | 2020-12-31 | $6,461,013 |
| Total plan assets at beginning of year | 2020-12-31 | $5,719,096 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $-767,658 |
| Other income received | 2020-12-31 | $990,962 |
| Net income (gross income less expenses) | 2020-12-31 | $741,917 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $6,461,013 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $5,719,096 |
| 2019 : AHCS RETIREE BENEFITS PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $1,897,883 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $809,349 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $738,404 |
| Total plan assets at end of year | 2019-12-31 | $5,719,096 |
| Total plan assets at beginning of year | 2019-12-31 | $4,630,562 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $70,945 |
| Other income received | 2019-12-31 | $1,897,883 |
| Net income (gross income less expenses) | 2019-12-31 | $1,088,534 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $5,719,096 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $4,630,562 |
| 2018 : AHCS RETIREE BENEFITS PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $433,377 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $2,224,882 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $774,135 |
| Total plan assets at end of year | 2018-12-31 | $4,630,562 |
| Total plan assets at beginning of year | 2018-12-31 | $6,422,067 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $1,450,747 |
| Other income received | 2018-12-31 | $433,377 |
| Net income (gross income less expenses) | 2018-12-31 | $-1,791,505 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $4,630,562 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $6,422,067 |
| 2017 : AHCS RETIREE BENEFITS PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $1,191,968 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,594,120 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $969,097 |
| Total plan assets at end of year | 2017-12-31 | $6,422,067 |
| Total plan assets at beginning of year | 2017-12-31 | $6,824,219 |
| Value of fidelity bond covering the plan | 2017-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $625,023 |
| Other income received | 2017-12-31 | $1,191,968 |
| Net income (gross income less expenses) | 2017-12-31 | $-402,152 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $6,422,067 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $6,824,219 |
| 2016 : AHCS RETIREE BENEFITS PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $961,752 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,003,410 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $970,615 |
| Total plan assets at end of year | 2016-12-31 | $6,824,219 |
| Total plan assets at beginning of year | 2016-12-31 | $6,865,877 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $32,795 |
| Other income received | 2016-12-31 | $961,752 |
| Net income (gross income less expenses) | 2016-12-31 | $-41,658 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $6,824,219 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $6,865,877 |
| 2015 : AHCS RETIREE BENEFITS PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $503,866 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,178,829 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,141,884 |
| Total plan assets at end of year | 2015-12-31 | $6,865,877 |
| Total plan assets at beginning of year | 2015-12-31 | $7,540,840 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $36,945 |
| Other income received | 2015-12-31 | $503,866 |
| Net income (gross income less expenses) | 2015-12-31 | $-674,963 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $6,865,877 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $7,540,840 |
| 2014 : AHCS RETIREE BENEFITS PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $973,493 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,399,107 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,371,347 |
| Total plan assets at end of year | 2014-12-31 | $7,540,840 |
| Total plan assets at beginning of year | 2014-12-31 | $7,966,454 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $27,760 |
| Other income received | 2014-12-31 | $973,493 |
| Net income (gross income less expenses) | 2014-12-31 | $-425,614 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $7,540,840 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $7,966,454 |
| 2013 : AHCS RETIREE BENEFITS PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $1,244,120 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $1,099,064 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $1,083,665 |
| Total plan assets at end of year | 2013-12-31 | $7,966,454 |
| Total plan assets at beginning of year | 2013-12-31 | $7,821,398 |
| Value of fidelity bond covering the plan | 2013-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $15,399 |
| Other income received | 2013-12-31 | $1,244,120 |
| Net income (gross income less expenses) | 2013-12-31 | $145,056 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $7,966,454 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $7,821,398 |
| 2012 : AHCS RETIREE BENEFITS PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $586,936 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $826,787 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $809,894 |
| Total plan assets at end of year | 2012-12-31 | $7,821,398 |
| Total plan assets at beginning of year | 2012-12-31 | $8,061,249 |
| Value of fidelity bond covering the plan | 2012-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $16,893 |
| Other income received | 2012-12-31 | $586,936 |
| Net income (gross income less expenses) | 2012-12-31 | $-239,851 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $7,821,398 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $8,061,249 |
| 2011 : AHCS RETIREE BENEFITS PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $474,880 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $1,403,350 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $1,390,248 |
| Total plan assets at end of year | 2011-12-31 | $8,061,249 |
| Total plan assets at beginning of year | 2011-12-31 | $8,989,719 |
| Value of fidelity bond covering the plan | 2011-12-31 | $500,000 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $13,102 |
| Other income received | 2011-12-31 | $474,880 |
| Net income (gross income less expenses) | 2011-12-31 | $-928,470 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $8,061,249 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $8,989,719 |
| 2010 : AHCS RETIREE BENEFITS PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $1,117,429 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $1,492,424 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $1,492,424 |
| Total plan assets at end of year | 2010-12-31 | $8,989,719 |
| Total plan assets at beginning of year | 2010-12-31 | $9,364,714 |
| Value of fidelity bond covering the plan | 2010-12-31 | $500,000 |
| Other income received | 2010-12-31 | $864,867 |
| Net income (gross income less expenses) | 2010-12-31 | $-374,995 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $8,989,719 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $9,364,714 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $252,562 |
| 2023: AHCS RETIREE BENEFITS PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: AHCS RETIREE BENEFITS PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: AHCS RETIREE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: AHCS RETIREE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: AHCS RETIREE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: AHCS RETIREE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: AHCS RETIREE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: AHCS RETIREE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: AHCS RETIREE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: AHCS RETIREE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: AHCS RETIREE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: AHCS RETIREE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: AHCS RETIREE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: AHCS RETIREE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395257G* |
| Policy instance | 2 |
| Insurance contract or identification number | 395257G* | | Number of Individuals Covered | 121 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,513 | | Total amount of fees paid to insurance company | USD $57,745 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $90,726 | | 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 | SEE BELOW* |
| Policy instance | 1 |
| Insurance contract or identification number | SEE BELOW* | | Number of Individuals Covered | 89 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $721,770 | | 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 | *SEE BELOW |
| Policy instance | 1 |
| Insurance contract or identification number | *SEE BELOW | | Number of Individuals Covered | 97 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $781,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395257G* |
| Policy instance | 2 |
| Insurance contract or identification number | 395257G* | | Number of Individuals Covered | 691 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,883 | | Total amount of fees paid to insurance company | USD $49,354 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $95,898 | | 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 | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395257G |
| Policy instance | 2 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395257G* |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395257G |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | *SEE BELOW |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 367216* |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 367216* |
| Policy instance | 1 |
