REFRESHMENT SERVICES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH
401k plan membership statisitcs for REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH
| Measure | Date | Value |
|---|
| 2022: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 286 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 282 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 11 |
| Total of all active and inactive participants | 2022-06-01 | 297 |
| 2021: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 298 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 286 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 4 |
| Total of all active and inactive participants | 2021-06-01 | 290 |
| 2020: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 305 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 298 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 298 |
| Total of all active and inactive participants | 2020-06-01 | 600 |
| 2019: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 305 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 4 |
| Total of all active and inactive participants | 2019-06-01 | 309 |
| 2018: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 299 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 294 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 3 |
| Total of all active and inactive participants | 2018-06-01 | 297 |
| 2017: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 320 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 296 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 3 |
| Total of all active and inactive participants | 2017-06-01 | 299 |
| 2016: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 334 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 316 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 4 |
| Total of all active and inactive participants | 2016-06-01 | 320 |
| 2015: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 289 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 429 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 4 |
| Total of all active and inactive participants | 2015-06-01 | 433 |
| 2014: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 302 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 288 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 1 |
| Total of all active and inactive participants | 2014-06-01 | 289 |
| 2013: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 478 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 489 |
| Total of all active and inactive participants | 2013-06-01 | 489 |
| 2012: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 285 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 478 |
| Total of all active and inactive participants | 2012-06-01 | 478 |
| 2011: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 238 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 285 |
| Total of all active and inactive participants | 2011-06-01 | 285 |
| 2010: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-06-01 | 299 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 238 |
| Total of all active and inactive participants | 2010-06-01 | 238 |
| 2009: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 299 |
| Total of all active and inactive participants | 2009-06-01 | 299 |
| 2022: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2022 form 5500 responses |
|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2021 form 5500 responses |
|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2010 form 5500 responses |
|---|
| 2010-06-01 | Type of plan entity | Single employer plan |
| 2010-06-01 | Plan funding arrangement – Insurance | Yes |
| 2010-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: REFRESHMENT SERVICES, INC. GROUP INSURANCE HEALTH 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 282 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $31,704 | | Total amount of fees paid to insurance company | USD $10,568 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $211,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,704 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10568 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 2 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,786 | | Total amount of fees paid to insurance company | USD $1,375 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $157,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,786 | | Amount paid for insurance broker fees | 1375 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $53,520 | | Total amount of fees paid to insurance company | USD $2,100 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $564,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,520 | | Amount paid for insurance broker fees | 2100 | | Insurance broker organization code? | 4 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 547 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $52,400 | | Total amount of fees paid to insurance company | USD $2,108 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $527,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,400 | | Amount paid for insurance broker fees | 2108 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 4 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 2 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 535 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $15,696 | | Total amount of fees paid to insurance company | USD $2,100 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $159,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,696 | | Amount paid for insurance broker fees | 2100 | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 286 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $30,129 | | Total amount of fees paid to insurance company | USD $10,043 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $200,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,129 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10043 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 298 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $30,413 | | Total amount of fees paid to insurance company | USD $10,138 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | 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 | | Commission paid to Insurance Broker | USD $30,413 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10138 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 2 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 557 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,933 | | Total amount of fees paid to insurance company | USD $2,108 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $162,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,933 | | Amount paid for insurance broker fees | 2108 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 605 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $55,376 | | Total amount of fees paid to insurance company | USD $2,048 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $562,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,376 | | Amount paid for insurance broker fees | 2048 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 4 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 2 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 555 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $14,463 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,463 | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 305 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $30,009 | | Total amount of fees paid to insurance company | USD $24,102 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $200,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,009 | | Amount paid for insurance broker fees | 10071 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $53,744 | | Total amount of fees paid to insurance company | USD $1,415 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $468,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,744 | | Amount paid for insurance broker fees | 1415 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,816 | | Total amount of fees paid to insurance company | USD $123 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,816 | | Amount paid for insurance broker fees | 123 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,444 | | Total amount of fees paid to insurance company | USD $540 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,444 | | Amount paid for insurance broker fees | 129 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 586 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,276 | | Total amount of fees paid to insurance company | USD $513 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,276 | | Amount paid for insurance broker fees | 513 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,549 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,549 | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018/P93018 | | Number of Individuals Covered | 578 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $52,278 | | Total amount of fees paid to insurance company | USD $2,691 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $335,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,278 | | Amount paid for insurance broker fees | 2691 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 504 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,759 | | Total amount of fees paid to insurance company | USD $239 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $132,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,759 | | Amount paid for insurance broker fees | 239 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018/P93018 | | Number of Individuals Covered | 661 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $63,207 | | Total amount of fees paid to insurance company | USD $2,520 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $208,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,207 | | Amount paid for insurance broker fees | 2520 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,521 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,521 | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $14,692 | | Total amount of fees paid to insurance company | USD $146 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,469 | | Amount paid for insurance broker fees | 146 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,613 | | Total amount of fees paid to insurance company | USD $71 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,633 | | Amount paid for insurance broker fees | 71 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,980 | | Total amount of fees paid to insurance company | USD $382 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,140 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,046 | | Amount paid for insurance broker fees | 71 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 666 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $10,406 | | Total amount of fees paid to insurance company | USD $311 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $151,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,848 | | Amount paid for insurance broker fees | 311 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 633 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,788 | | Total amount of fees paid to insurance company | USD $498 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,544 | | Amount paid for insurance broker fees | 498 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,044 | | Total amount of fees paid to insurance company | USD $109 | | 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 $32,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,082 | | Amount paid for insurance broker fees | 109 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,584 | | Total amount of fees paid to insurance company | USD $107 | | 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 $32,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,615 | | Amount paid for insurance broker fees | 107 | | Additional information about fees paid to insurance broker | BONUSBONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,498 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,498 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,583 | | Total amount of fees paid to insurance company | USD $230 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $68,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,525 | | Amount paid for insurance broker fees | 230 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 993018/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 993018/P93018 | | Number of Individuals Covered | 644 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $53,165 | | Total amount of fees paid to insurance company | USD $2,820 | | 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 $203,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,165 | | Amount paid for insurance broker fees | 2820 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 658 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $9,166 | | Total amount of fees paid to insurance company | USD $483 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,233 | | Amount paid for insurance broker fees | 483 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,954 | | Total amount of fees paid to insurance company | USD $385 | | 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 $28,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,954 | | Amount paid for insurance broker fees | 96 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 9/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 9/P93018 | | Number of Individuals Covered | 669 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $57,312 | | Total amount of fees paid to insurance company | USD $2,849 | | 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 $199,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,312 | | Amount paid for insurance broker fees | 2849 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,404 | | Total amount of fees paid to insurance company | USD $103 | | 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 $28,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,404 | | Amount paid for insurance broker fees | 103 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 489 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $10,523 | | Total amount of fees paid to insurance company | USD $218 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $62,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,523 | | Amount paid for insurance broker fees | 218 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | RW GARRETT AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,406 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,406 | | Insurance broker name | RW GARRETT AGENCY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 662 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $10,264 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,782 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,885 | | Total amount of fees paid to insurance company | USD $298 | | 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 $29,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,992 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 298 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,548 | | 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 $31,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,593 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,842 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $70,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,737 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,392 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,522 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,392 | | Insurance broker name | RW GARRETT AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 9/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 9/P93018 | | Number of Individuals Covered | 717 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $56,849 | | Total amount of fees paid to insurance company | USD $1,639 | | 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 $191,999 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,849 | | Amount paid for insurance broker fees | 1639 | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,362 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,567 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $53,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,454 | | Total amount of fees paid to insurance company | USD $239 | | 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 $23,934 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 6 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,628 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,127 | | 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 | 9/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 9/P93018 | | Number of Individuals Covered | 736 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $50,686 | | Total amount of fees paid to insurance company | USD $6,846 | | 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 $176,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,928 | | 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 $24,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 5 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,653 | | Total amount of fees paid to insurance company | USD $265 | | 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 $26,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,859 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 265 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 4 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,081 | | 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 $26,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,301 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H30761 |
| Policy instance | 3 |
| Insurance contract or identification number | H30761 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $8,660 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $58,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,980 | | Insurance broker name | GROUP MARKETING SERVICES, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12276349 |
| Policy instance | 2 |
| Insurance contract or identification number | 12276349 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,348 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,057 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,348 | | Insurance broker name | RW GARRETT AGENCY |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 9/P93018 |
| Policy instance | 1 |
| Insurance contract or identification number | 9/P93018 | | Number of Individuals Covered | 702 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $45,692 | | Total amount of fees paid to insurance company | USD $2,778 | | 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 $130,299 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,692 | | Amount paid for insurance broker fees | 2778 | | Insurance broker organization code? | 3 | | Insurance broker name | RW GARRETT AGENCY |
|
