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DOT FOODS INC WELFARE PLAN 401k Plan overview

Plan NameDOT FOODS INC WELFARE PLAN
Plan identification number 502

DOT FOODS INC WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

DOT FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name:DOT FOODS, INC.
Employer identification number (EIN):370863139
NAIC Classification:424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOT FOODS INC WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-01-01TOM STRIEKER
5022016-01-01TOM STRIEKER
5022015-01-01TOM STRIEKER
5022014-01-01TOM STRIEKER
5022014-01-01TOM STRIEKER
5022013-01-01TOM STRIEKER
5022012-01-01TOM STRIEKER
5022011-01-01TOM STRIEKER
5022010-01-01TOM STRIEKER
5022009-01-01THOMAS STRIEKER
5022009-01-01 THOMAS STRIEKER2010-10-08

Plan Statistics for DOT FOODS INC WELFARE PLAN

401k plan membership statisitcs for DOT FOODS INC WELFARE PLAN

Measure Date Value
2017: DOT FOODS INC WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-014,248
Total number of active participants reported on line 7a of the Form 55002017-01-014,503
Number of retired or separated participants receiving benefits2017-01-0116
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-014,519
2016: DOT FOODS INC WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-013,716
Total number of active participants reported on line 7a of the Form 55002016-01-014,248
Number of retired or separated participants receiving benefits2016-01-0123
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-014,271
2015: DOT FOODS INC WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013,747
Total number of active participants reported on line 7a of the Form 55002015-01-013,716
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-013,716
2014: DOT FOODS INC WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013,706
Total number of active participants reported on line 7a of the Form 55002014-01-013,731
Number of retired or separated participants receiving benefits2014-01-0116
Total of all active and inactive participants2014-01-013,747
Total participants2014-01-010
2013: DOT FOODS INC WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013,401
Total number of active participants reported on line 7a of the Form 55002013-01-013,706
Number of retired or separated participants receiving benefits2013-01-0119
Total of all active and inactive participants2013-01-013,725
Total participants2013-01-010
2012: DOT FOODS INC WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,803
Total number of active participants reported on line 7a of the Form 55002012-01-013,387
Number of retired or separated participants receiving benefits2012-01-0114
Total of all active and inactive participants2012-01-013,401
Total participants2012-01-010
2011: DOT FOODS INC WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-012,804
Total number of active participants reported on line 7a of the Form 55002011-01-012,793
Number of retired or separated participants receiving benefits2011-01-0110
Total of all active and inactive participants2011-01-012,803
Total participants2011-01-012,803
2010: DOT FOODS INC WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-012,777
Total number of active participants reported on line 7a of the Form 55002010-01-012,787
Number of retired or separated participants receiving benefits2010-01-0117
Total of all active and inactive participants2010-01-012,804
Total participants2010-01-012,804
2009: DOT FOODS INC WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,850
Total number of active participants reported on line 7a of the Form 55002009-01-012,761
Number of retired or separated participants receiving benefits2009-01-0116
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-012,777

Form 5500 Responses for DOT FOODS INC WELFARE PLAN

2017: DOT FOODS INC WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: DOT FOODS INC WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: DOT FOODS INC WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: DOT FOODS INC WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: DOT FOODS INC WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: DOT FOODS INC WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: DOT FOODS INC WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: DOT FOODS INC WELFARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: DOT FOODS INC WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number014510
Policy instance 8
Insurance contract or identification number014510
Number of Individuals Covered9819
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,171,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963490
Policy instance 1
Insurance contract or identification numberLK 963490
Number of Individuals Covered4391
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $2,170
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $436,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2170
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameAON CONSULTING
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966635
Policy instance 2
Insurance contract or identification numberOK 966635
Number of Individuals Covered4503
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $270
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $49,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees270
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameAON CONSULTING INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966037
Policy instance 3
Insurance contract or identification numberFLX966037
Number of Individuals Covered4306
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $74,213
Total amount of fees paid to insurance companyUSD $54,014
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $742,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,213
Amount paid for insurance broker fees54014
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameAON CONSULTING
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965032
Policy instance 4
Insurance contract or identification numberFLX965032
Number of Individuals Covered4503
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $861
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees861
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameAON CONSULTING INC
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075041
Policy instance 5
Insurance contract or identification numberNYD075041
Number of Individuals Covered276
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $226
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $35,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees226
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameAON CONSULTING INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number30069864
Policy instance 6
Insurance contract or identification number30069864
Number of Individuals Covered3460
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number68088-5
Policy instance 7
Insurance contract or identification number68088-5
Number of Individuals Covered2021
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $71,411
Other welfare benefits providedACCIDENT & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $588,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,864
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966037
Policy instance 3
Insurance contract or identification numberFLX966037
Number of Individuals Covered4189
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $54,997
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $549,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,997
Insurance broker organization code?3
Insurance broker nameAON CONSULTING
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 4
Insurance contract or identification number12088655
Number of Individuals Covered3072
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,835
Total amount of fees paid to insurance companyUSD $191
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,835
Amount paid for insurance broker fees191
Additional information about fees paid to insurance brokerOUTSTANDING COMMISSIONS/FEES
Insurance broker organization code?3
Insurance broker nameAON CONSULTING INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965032
Policy instance 5
Insurance contract or identification numberFLX965032
Number of Individuals Covered3716
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $22
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075041
Policy instance 6
Insurance contract or identification numberNYD075041
Number of Individuals Covered3592
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $34,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number68088-5
Policy instance 7
Insurance contract or identification number68088-5
Number of Individuals Covered944
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $131,907
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $394,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $131,907
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number68088-5
Policy instance 8
Insurance contract or identification number68088-5
Number of Individuals Covered1794
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $31,930
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $537,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,930
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number014510
Policy instance 9
Insurance contract or identification number014510
Number of Individuals Covered8841
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $983,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966635
Policy instance 2
Insurance contract or identification numberOK 966635
Number of Individuals Covered3716
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $40,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8
Additional information about fees paid to insurance brokerSUPP COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963490
Policy instance 1
Insurance contract or identification numberLK 963490
Number of Individuals Covered3824
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $55
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number68088-5
Policy instance 8
Insurance contract or identification number68088-5
Number of Individuals Covered735
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $131,907
Other welfare benefits providedCRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $394,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $131,907
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number014510
Policy instance 1
Insurance contract or identification number014510
Number of Individuals Covered8329
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $16,557
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,031,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees16557
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963490
Policy instance 2
Insurance contract or identification numberLK 963490
Number of Individuals Covered3553
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $7,507
Total amount of fees paid to insurance companyUSD $2,759
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $326,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,507
Amount paid for insurance broker fees2759
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966635
Policy instance 3
Insurance contract or identification numberOK 966635
Number of Individuals Covered3693
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of fees paid to insurance companyUSD $380
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $47,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees380
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966037
Policy instance 4
Insurance contract or identification numberFLX966037
Number of Individuals Covered3693
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $51,087
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $510,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,087
Insurance broker nameAON CONSULTING
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 5
Insurance contract or identification number12088655
Number of Individuals Covered2833
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,765
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,765
Insurance broker nameAON CONSULTING INC
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberNYD075041
Policy instance 7
Insurance contract or identification numberNYD075041
Number of Individuals Covered3348
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $1,334
Total amount of fees paid to insurance companyUSD $358
Other welfare benefits providedSTATUTORY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $35,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,334
Amount paid for insurance broker fees358
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker nameMERCER HEALTH & BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965032
Policy instance 6
Insurance contract or identification numberFLX965032
Number of Individuals Covered3693
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $20,147
Total amount of fees paid to insurance companyUSD $2,503
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $244,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,147
Amount paid for insurance broker fees2503
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965032
Policy instance 4
Insurance contract or identification numberFLX965032
Number of Individuals Covered3381
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $72,084
Total amount of fees paid to insurance companyUSD $4,723
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $504,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,084
Amount paid for insurance broker fees4723
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 966635
Policy instance 3
Insurance contract or identification numberOK 966635
Number of Individuals Covered3381
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of fees paid to insurance companyUSD $290
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $30,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees290
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 963490
Policy instance 2
Insurance contract or identification numberLK 963490
Number of Individuals Covered3381
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $31,597
Total amount of fees paid to insurance companyUSD $2,133
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $220,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,597
Amount paid for insurance broker fees2133
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSION
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number014510
Policy instance 1
Insurance contract or identification number014510
Number of Individuals Covered8037
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $21,549
Total amount of fees paid to insurance companyUSD $20,408
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $902,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,549
Amount paid for insurance broker fees20408
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 5
Insurance contract or identification number12088655
Number of Individuals Covered2555
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,348
Total amount of fees paid to insurance companyUSD $129
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,259
Amount paid for insurance broker fees129
Additional information about fees paid to insurance brokerOUTSTANDING COMMISSIONS/FEES
Insurance broker nameAON CONSULTING INC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number14510
Policy instance 3
Insurance contract or identification number14510
Number of Individuals Covered7418
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $26,142
Total amount of fees paid to insurance companyUSD $19,216
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $765,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,142
Amount paid for insurance broker fees19216
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675961G
Policy instance 2
Insurance contract or identification number675961G
Number of Individuals Covered3137
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $90,182
Total amount of fees paid to insurance companyUSD $15,400
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $940,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees15400
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $90,182
Insurance broker nameMERCER HEALTH & BENEFITS LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 1
Insurance contract or identification number12088655
Number of Individuals Covered2356
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,235
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,235
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number14510
Policy instance 3
Insurance contract or identification number14510
Number of Individuals Covered6865
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $15,895
Total amount of fees paid to insurance companyUSD $15,455
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $597,895
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 number675961G
Policy instance 2
Insurance contract or identification number675961G
Number of Individuals Covered2978
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $80,490
Total amount of fees paid to insurance companyUSD $8,848
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $828,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 1
Insurance contract or identification number12088655
Number of Individuals Covered2186
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,173
Vision Insurance Welfare BenefitYes
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 number14510
Policy instance 3
Insurance contract or identification number14510
Number of Individuals Covered6559
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,207
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $588,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,207
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675961G
Policy instance 2
Insurance contract or identification number675961G
Number of Individuals Covered2788
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $74,993
Total amount of fees paid to insurance companyUSD $6,220
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $728,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6220
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $74,993
Insurance broker nameMERCER HEALTH & BENEFITS LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number12088655
Policy instance 1
Insurance contract or identification number12088655
Number of Individuals Covered2044
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,037
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,037
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC

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