UFTRING CHEVROLET, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UFTRING AUTO GROUP SECTION 125 PLAN
Measure | Date | Value |
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2022: UFTRING AUTO GROUP SECTION 125 PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 285 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 294 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 294 |
2021: UFTRING AUTO GROUP SECTION 125 PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 300 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 285 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 285 |
2020: UFTRING AUTO GROUP SECTION 125 PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 325 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 300 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 300 |
2019: UFTRING AUTO GROUP SECTION 125 PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 325 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 325 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 325 |
2018: UFTRING AUTO GROUP SECTION 125 PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 310 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 325 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 325 |
2017: UFTRING AUTO GROUP SECTION 125 PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 333 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 310 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 310 |
2016: UFTRING AUTO GROUP SECTION 125 PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 355 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 333 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 333 |
2015: UFTRING AUTO GROUP SECTION 125 PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 315 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 355 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 355 |
2014: UFTRING AUTO GROUP SECTION 125 PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 292 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 315 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 315 |
2013: UFTRING AUTO GROUP SECTION 125 PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 324 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 292 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 292 |
2012: UFTRING AUTO GROUP SECTION 125 PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 312 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 324 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
Total of all active and inactive participants | 2012-01-01 | 324 |
2011: UFTRING AUTO GROUP SECTION 125 PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 312 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
Total of all active and inactive participants | 2011-01-01 | 312 |
2009: UFTRING AUTO GROUP SECTION 125 PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 281 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 282 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
Total of all active and inactive participants | 2009-01-01 | 282 |
2022: UFTRING AUTO GROUP SECTION 125 PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: UFTRING AUTO GROUP SECTION 125 PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: UFTRING AUTO GROUP SECTION 125 PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: UFTRING AUTO GROUP SECTION 125 PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: UFTRING AUTO GROUP SECTION 125 PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: UFTRING AUTO GROUP SECTION 125 PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: UFTRING AUTO GROUP SECTION 125 PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: UFTRING AUTO GROUP SECTION 125 PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: UFTRING AUTO GROUP SECTION 125 PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: UFTRING AUTO GROUP SECTION 125 PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: UFTRING AUTO GROUP SECTION 125 PLAN 2012 form 5500 responses |
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2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Plan funding arrangement – Insurance | Yes |
2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-01-01 | Plan benefit arrangement – Insurance | Yes |
2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: UFTRING AUTO GROUP SECTION 125 PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: UFTRING AUTO GROUP SECTION 125 PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | First time form 5500 has been submitted | Yes |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 77718 |
Policy instance | 7 |
Insurance contract or identification number | 77718 | Number of Individuals Covered | 22 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $1,705 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $16,340 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $905 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 409 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $61,407 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $640,402 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,407 | Insurance broker organization code? | 3 |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 280 | Insurance policy start date | 2021-03-02 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,147 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,312 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,147 | Insurance broker organization code? | 3 |
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GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 3 |
Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $12,145 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $12,145 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768 |
Policy instance | 4 |
Insurance contract or identification number | 83768 | Number of Individuals Covered | 5 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $323 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $3,338 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $162 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | C9283 |
Policy instance | 5 |
Insurance contract or identification number | C9283 | Number of Individuals Covered | 10 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $608 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $5,192 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $339 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EE625 |
Policy instance | 6 |
Insurance contract or identification number | EE625 | Number of Individuals Covered | 4 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $191 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $112 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 451 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $66,747 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $647,874 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $66,747 | Insurance broker organization code? | 3 |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 295 | Insurance policy start date | 2020-03-02 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $2,301 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,338 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,301 | Insurance broker organization code? | 3 |
|
GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 3 |
Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of fees paid to insurance company | USD $13,254 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 13254 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768 |
Policy instance | 4 |
Insurance contract or identification number | 83768 | Number of Individuals Covered | 7 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $437 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $4,460 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $259 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EE625 |
Policy instance | 6 |
Insurance contract or identification number | EE625 | Number of Individuals Covered | 4 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $190 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $1,880 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $111 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 77718 |
Policy instance | 7 |
Insurance contract or identification number | 77718 | Number of Individuals Covered | 24 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $2,003 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $18,995 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,096 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | C9283 |
Policy instance | 5 |
Insurance contract or identification number | C9283 | Number of Individuals Covered | 12 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $708 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $6,120 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $410 | Insurance broker organization code? | 3 |
|
PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 318 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $2,442 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,277 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,442 | Insurance broker organization code? | 3 |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 479 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $70,724 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $532,822 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $70,724 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 77718 |
Policy instance | 7 |
Insurance contract or identification number | 77718 | Number of Individuals Covered | 26 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $2,207 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $20,653 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,231 | Insurance broker organization code? | 3 |
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GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 3 |
Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of fees paid to insurance company | USD $13,820 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 13820 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768 |
Policy instance | 4 |
Insurance contract or identification number | 83768 | Number of Individuals Covered | 9 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $419 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $4,353 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $260 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | C9283 |
Policy instance | 5 |
Insurance contract or identification number | C9283 | Number of Individuals Covered | 12 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $759 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $6,602 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $443 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EE625 |
Policy instance | 6 |
Insurance contract or identification number | EE625 | Number of Individuals Covered | 4 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $191 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $112 | Insurance broker organization code? | 3 |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 470 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $86,692 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $424,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $68,564 | Insurance broker organization code? | 3 |
|
PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 305 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $2,365 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,365 | Insurance broker organization code? | 3 |
|
GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 3 |
Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of fees paid to insurance company | USD $13,584 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 13584 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768 |
Policy instance | 4 |
Insurance contract or identification number | 83768 | Number of Individuals Covered | 10 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $469 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $4,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $290 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | EE625 |
Policy instance | 6 |
Insurance contract or identification number | EE625 | Number of Individuals Covered | 3 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $191 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $1,888 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $112 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | C9283 |
Policy instance | 5 |
Insurance contract or identification number | C9283 | Number of Individuals Covered | 17 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $1,120 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $9,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $632 | Insurance broker organization code? | 3 |
|
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 77718 |
Policy instance | 7 |
Insurance contract or identification number | 77718 | Number of Individuals Covered | 29 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $2,358 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $22,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,307 | Insurance broker organization code? | 3 |
|
GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 3 |
Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of fees paid to insurance company | USD $13,456 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 13456 | Insurance broker organization code? | 3 |
|
PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 306 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $2,419 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,128 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,419 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 480 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $70,948 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $397,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $70,948 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 206788 |
Policy instance | 1 |
Insurance contract or identification number | 206788 | Number of Individuals Covered | 497 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $76,450 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $317,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $76,450 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE SERVICES INC |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 309 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,435 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,435 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768, C9283 |
Policy instance | 3 |
Insurance contract or identification number | 83768, C9283 | Number of Individuals Covered | 62 | Insurance policy start date | 2016-03-01 | Insurance policy end date | 2017-02-28 | Total amount of commissions paid to insurance broker | USD $4,361 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $38,363 | 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 organization code? | 3 | Insurance broker name | GEORGE OWENS |
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GROUP PLAN SOLUTIONS BENEFIT ADMINISTRATION (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 4 |
Insurance policy start date | 2016-04-01 | Insurance policy end date | 2017-03-31 | Total amount of fees paid to insurance company | USD $14,315 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 14315 | Insurance broker organization code? | 3 | Insurance broker name | LARRY HARDESTY |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | C9283, EE625 |
Policy instance | 5 |
Insurance contract or identification number | C9283, EE625 | Number of Individuals Covered | 20 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,389 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $12,430 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $471 | Insurance broker organization code? | 3 | Insurance broker name | KYLE HORN |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400, P75786 |
Policy instance | 1 |
Insurance contract or identification number | P07400, P75786 | Number of Individuals Covered | 449 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $61,834 | Total amount of fees paid to insurance company | USD $45 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $282,584 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,834 | Amount paid for insurance broker fees | 23 | Additional information about fees paid to insurance broker | MISC GIFTS, MEALS, MEETINGS | Insurance broker organization code? | 3 | Insurance broker name | UFTRING DEALERSHIPS |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 311 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $971 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $971 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 257 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $3,019 | Total amount of fees paid to insurance company | USD $19,345 | Dental 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 $3,019 | Amount paid for insurance broker fees | 19345 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768, C9283 |
Policy instance | 4 |
Insurance contract or identification number | 83768, C9283 | Number of Individuals Covered | 68 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $5,205 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $45,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $5 | Insurance broker organization code? | 3 | Insurance broker name | WAYNE ROWE |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 292 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $2,249 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,991 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,249 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 243 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $2,952 | Total amount of fees paid to insurance company | USD $18,994 | Dental 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 $2,952 | Amount paid for insurance broker fees | 18994 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768, C9283 |
Policy instance | 4 |
Insurance contract or identification number | 83768, C9283 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-02-28 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 | Insurance broker name | WAYNE ROWE |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400, P79705 |
Policy instance | 1 |
Insurance contract or identification number | P07400, P79705 | Number of Individuals Covered | 474 | Insurance policy start date | 2013-03-01 | Insurance policy end date | 2014-02-28 | Total amount of commissions paid to insurance broker | USD $55,526 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $228,476 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $55,526 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400, P79705 |
Policy instance | 1 |
Insurance contract or identification number | P07400, P79705 | Number of Individuals Covered | 453 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $71,893 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $244,745 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $71,893 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 236 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $3,202 | Total amount of fees paid to insurance company | USD $18,345 | Dental 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 $3,202 | Amount paid for insurance broker fees | 18345 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768, C9283 |
Policy instance | 4 |
Insurance contract or identification number | 83768, C9283 | Number of Individuals Covered | 84 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $7,817 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $57,396 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8 | Insurance broker organization code? | 3 | Insurance broker name | WAYNE ROWE |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 305 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $2,300 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,334 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,300 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 58-0663085 |
Policy instance | 4 |
Insurance contract or identification number | 58-0663085 | Number of Individuals Covered | 89 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $6,969 | Other welfare benefits provided | OTHER (SUPPLEMENTAL POLICIES) | Welfare Benefit Premiums Paid to Carrier | USD $55,631 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,108 | Insurance broker organization code? | 3 | Insurance broker name | JENNIFER WOODRUM |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 252 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,779 | Total amount of fees paid to insurance company | USD $18,782 | Dental 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 $2,779 | Amount paid for insurance broker fees | 18782 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE SERVICES I |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 301 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,294 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,290 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,294 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400, P79705 |
Policy instance | 1 |
Insurance contract or identification number | P07400, P79705 | Number of Individuals Covered | 465 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $87,256 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $206,735 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $87,256 | Insurance broker organization code? | 3 | Insurance broker name | MID ILLINOIS INSURANCE |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 258 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,585 | Total amount of fees paid to insurance company | USD $19,329 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82768 C9283 |
Policy instance | 4 |
Insurance contract or identification number | 82768 C9283 | Number of Individuals Covered | 92 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $9,935 | Total amount of fees paid to insurance company | USD $128 | Other welfare benefits provided | OTHER SUPPLEMENTAL POLICIES | Welfare Benefit Premiums Paid to Carrier | USD $60,017 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 317 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $2,266 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400 P79705 |
Policy instance | 1 |
Insurance contract or identification number | P07400 P79705 | Number of Individuals Covered | 456 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $45,458 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $148,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | P07400 P79705 |
Policy instance | 1 |
Insurance contract or identification number | P07400 P79705 | Number of Individuals Covered | 442 | Insurance policy start date | 2009-03-01 | Insurance policy end date | 2010-02-28 | Total amount of commissions paid to insurance broker | USD $37,541 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $125,603 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PEKIN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67628 ) |
Policy contract number | JW00190640 |
Policy instance | 2 |
Insurance contract or identification number | JW00190640 | Number of Individuals Covered | 304 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $2,264 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,096 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 559943 |
Policy instance | 3 |
Insurance contract or identification number | 559943 | Number of Individuals Covered | 250 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $2,188 | Total amount of fees paid to insurance company | USD $13,487 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 83768 C9283 |
Policy instance | 4 |
Insurance contract or identification number | 83768 C9283 | Number of Individuals Covered | 81 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $7,628 | Total amount of fees paid to insurance company | USD $82 | Other welfare benefits provided | OTHER SUPPLEMENTAL POLICIES | Welfare Benefit Premiums Paid to Carrier | USD $54,395 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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